title: Attrition in nursing: perspectives from the national survey of college graduates.

text: Problems with attracting and retaining nurses during a tight labor market are compounded by some fundamental issues related to attrition from the field. It is important to recognize that, of the students who graduate from nursing schools each year and enter the field of nursing, significant attrition occurs during the first 5 years in the profession [www.aacn.nche.edu/media/backgrounders/shortagefacts.htmaacn.nche.edu (2002)]. This article uses data from the National Science Foundation's National Survey of College Graduates to examine various scenarios and possible reasons for why some nurses abandon their careers [www.nsf.gov/sbe/srs/snscg/start.htm (2003)]. In doing so, we consider entry into, and attrition from, the nursing profession at various stages. Using data from the National Survey of College Graduates, the initial evaluation suggests that, at points during the career, the individual confronts potential problems and issues which can lead to career attrition.


docid: wntjgtqa

title: Integrating hospitals into community emergency preparedness planning.

text: BACKGROUND Strong community linkages are essential to a health care organization's overall preparedness for emergencies. OBJECTIVE To assess community emergency preparedness linkages among hospitals, public health officials, and first responders and to investigate the influence of community hazards, previous preparation for an event requiring national security oversight, and experience responding to actual disasters. DESIGN With expert advice from an advisory panel, a mailed questionnaire was used to assess linkage issues related to training and drills, equipment, surveillance, laboratory testing, surge capacity, incident management, and communication. SETTING A simple random sample of 1750 U.S. medical-surgical hospitals. PARTICIPANTS Of 678 hospital representatives that agreed to participate, 575 (33%) completed the questionnaire in early 2004. Respondents were hospital personnel responsible for environmental safety, emergency management, infection control, administration, emergency services, and security. MEASUREMENTS Prevalence and breadth of participation in community-wide planning; examination of 17 basic elements in a weighted analysis. RESULTS In a weighted analysis, most hospitals (88.2% [95% CI, 84.1% to 92.3%]) engaged in community-wide drills and exercises, and most (82.2% [CI, 77.8% to 86.5%]) conducted a collaborative threat and vulnerability analysis with community responders. Of all respondents, 57.3% (CI, 52.1% to 62.5%) reported that their community plans addressed the hospital's need for additional supplies and equipment, and 73.0% (CI, 68.1% to 77.9%) reported that decontamination capacity needs were addressed. Fewer reported a direct link to the Health Alert Network (54.4% [CI, 49.3% to 59.5%]) and around-the-clock access to a live voice from a public health department (40.0% [CI, 35.0% to 45.0%]). Performance on many of 17 basic elements was better in large and urban hospitals and was associated with a high number of perceived hazards, previous national security event preparation, and experience in actual response. LIMITATIONS Responses reflect hospitals' self-perception of linkages. The quality of linkages and the extent of possible biases favoring positive responses were not assessed. CONCLUSIONS In this baseline assessment, most hospitals reported substantial integration. However, results suggest that relationships between hospitals, public health departments, and other critical response entities are not adequately robust. Suggestions for enhancing linkages are discussed.


docid: fsxnahpn

title: Updated SARS case definition using laboratory criteria.


title: The effect of two closely inserted transcription consensus sequences on coronavirus transcription.

text: Insertion of an intergenic region from the murine coronavirus mouse hepatitis virus into a mouse hepatitis virus defective interfering (DI) RNA led to transcription of subgenomic DI RNA in helper virus-infected cells. Using this system, we studied how two intergenic regions in close proximity affected subgenomic RNA synthesis. When two intergenic regions were separated by more than 100 nucleotides, slightly less of the larger subgenomic DI RNA (synthesized from the upstream intergenic region) was made; this difference was significant when the intergenic region separation was less than about 35 nucleotides. Deletion of sequences flanking the two intergenic regions inserted in close proximity did not affect transcription. No significant change in the ratio of the two subgenomic DI RNAs was observed when the sequence between the two intergenic regions was altered. Removal of the downstream intergenic region restored transcription of the larger subgenomic DI RNA. The UCUAAAC consensus sequence was needed for efficient suppression of the larger subgenomic DI RNA synthesis. These results demonstrated that the downstream intergenic sequence was suppressing subgenomic DI RNA synthesis from the upstream intergenic region. We discuss possible mechanisms to account for the regulation of this suppression of subgenomic DI RNA synthesis and the ways in which they relate to the general regulation of coronavirus transcription.


title: [Detection for severe acute respiratory syndrome (SARS) coronavirus RNA in stool of SARS patients].

text: OBJECTIVE To investigate excretion of severe acute respiratory syndrome coronavirus RNA (SARS-CoV) in stool of SARS patients. METHODS SARS-CoV RNA was detected in stool specimens with fluorescent quantitative polymerase chain reactions (FQ-PCR) in 101 SARS patients on the 10 to 55 days after onset, 27 non-SARS patients and 400 individuals with health check-up. RESULTS SARS-CoV RNA was positive in stool specimens by FQ-PCR in 58 of 101 SARS patients (57.4%), and all negative in 27 non-SARS patients and 400 healthy individuals. Positive rate of SARS-CoV RNA was 100% (8/8), 67.7% (21/31), 47.4% (27/57) and 40.0% (2/5) on the 10 - 19, 20 - 29, 30 - 39 and 40 - 55 days after onset of fever, respectively, with values of logarithm of SARS-CoV RNA load of 6.06 +/- 2.05, 4.51 +/- 1.23, 3.82 +/- 1.44 and 3.57 +/- 1.25, respectively. CONCLUSION Positive rate and load of SARS-CoV RNA in stool of SARS patients was the highest at their acute phase, and decreased with the extension of its course.


title: Uncut Roux-en-Y reconstruction after distal gastrectomy for gastric cancer.

text: INTRODUCTION Uncut Roux-en-Y gastrojejunostomy is a modification of the Billroth II procedure with Braun anastomosis, in which a jejunal occlusion is fashioned to avoid the Roux Stasis Syndrome. This review aimed to summarize the current knowledge about the uncut Roux-en-Y anastomosis operation, so that surgeons may be able to make informed decisions about its clinical application. Additionally, we hope that our findings will guide future research on this topic. Areas covered: The original uncut technique was associated with dehiscence or recanalization of the jejunal occlusion, and was therefore not widely applied. However, with recent improvements in the method of jejunal occlusion, the uncut Roux-en-Y reconstruction may be an appropriate alternative for digestive tract reconstruction after distal gastrectomy. This review summarizes the basic research on and clinical applications of uncut Roux-en-Y gastrojejunostomy from the following several aspects: origin of the uncut reconstruction technique, rationale for uncut reconstruction based on data from animal experiments, clinical results of the uncut reconstruction, recanalization and its countermeasures, and so on. Expert commentary: The uncut Roux-en-Y gastrojejunostomy is a controversial yet promising method of gastrointestinal reconstruction after distal gastrectomy. Prospective randomized controlled trials and long-term follow-up outcomes are required to support the modified technique in the future.


title: Systemic calicivirus epidemic in captive exotic felids.

text: A 5-day-old, mother-raised, Amur tiger cub (Panthera tigris altaica) presented with tongue ulcerations. Identical lesions appeared and progressed to sloughing of the tongue in the three littermates of this cub the following day. The lesions progressed in all cubs to include sloughing of the carpal, tarsal, metacarpal, and metatarsal foot pad epithelium. Oral ulcerations were also noted in adult African lions (Panthera leo) and Amur tigers (Panthera tigris altaica), but not in two adult snow leopards (Panthera uncia) housed in the same building. All adult cats had been previously vaccinated for common feline diseases including feline calicivirus (FCV). Detection of FCV RNA in oral secretions by a real-time reverse transcription polymerase chain reaction assay (RRT-PCR) confirmed FCV infection in the tiger cubs and one lion. A male lion and a male tiger cub died during the disease outbreak. RRT-PCR confirmed FCV in multiple tissues in both of these animals. A stray cat live-trapped outside the feline building during the epidemic was found to be positive for FCV by virus isolation and was thought to be the source of infection.


title: Intracellular synthesis, processing, and transport of proteins encoded by ORFs 5 to 7 of porcine reproductive and respiratory syndrome virus.

text: Porcine Reproductive and Respiratory Syndrome Virus (PRRSV), a small enveloped virus containing a positive-strand RNA genome, possesses at least three major structural proteins designated N, M, and E. The N protein is considered as the major component of the nucleocapsid, whereas M and E are membrane-associated. Previous studies using peptide-specific antibodies assigned these proteins to ORFs 7, 6, and 5, respectively. In the present report, monospecific antisera raised against Escherichia coli-expressed ORFs 5, 6, and 7 products were used to study the synthesis and processing of PRRSV structural proteins in the highly permissive MARC-145 cell line. Treatment of viral proteins with various glycosidases showed that only E was modified by N-linked glycans. Pulse-chase experiments revealed that intracellular transport of the major envelope glycoprotein was delayed in the premedial Golgi compartment. During the first 30 min of chase, E undergoes a gradual downward shift of its apparent molecular weight, thought to result from trimming of the mannose-rich glycan structures. Once E is transported to the medial Golgi or proximal elements, some molecules undergo complete processing of all their high-mannose N-linked oligosaccharides to complex type, while in other molecules only a fraction of N-linked glycans are terminally glycosylated. These two differentially glycosylated forms of E were found to be incorporated into extracellular virions. In cells and virions, both M and E were shown to occur in heterodimeric complexes linked by disulfide bonds. The oligomerization process, as analyzed from pulse-chase experiments, showed that M and E are incorporated into M-E complexes with different kinetics and efficiencies, in a fashion similar to their counterparts in equine arteritis virus. Apparently, all steps of E protein N-glycans processing proceed after its association with M which occurs in the endoplasmic reticulum (ER). In the infected cells, E and M appear highly membrane-associated, while N is predominantly cytosolic.


title: Allergic contact dermatitis from formaldehyde textile resins in surgical uniforms and nonwoven textile masks.

text: Despite a trend for reduction in the concentration of free formaldehyde in textiles, formaldehyde textile resin (FTR) allergic contact dermatitis (ACD) remains an important clinical issue and is likely underdiagnosed. Patients with FTR ACD may react to formaldehyde released from the resin or to the resin itself. Screening with formaldehyde and ethyleneurea/melamine formaldehyde resin will uncover most cases. Patch testing with the suspected offending fabric most often leads to false-negative results. We present a case of a 49-year-old pediatrician who developed a severe widespread dermatitis caused by contact with FTRs from her hospital "greens" ("scrubs") and mask.


title: Severe acute respiratory syndrome.

text: Severe acute respiratory syndrome (SARS) is a new disease that poses a threat to international health. The SARS epidemic earlier this year affected more than 30 countries and regions, with a cumulative global total of 8098 cases. It is caused by a novel coronavirus, probably of animal origin. The mean incubation period is 6.4 days (range 2-11 days). Patients usually present with high fever, chills, myalgia and dry cough, with or without chest X-ray evidence of pneumonia at the onset of disease. A history of contact with or travel to an area with local transmission is common. Diagnosis is based on clinical criteria, as a valid rapid diagnostic test is not yet available. There is no specific antiviral therapy for this disease, and no controlled clinical trial for any treatment modality has been conducted. In several retrospective studies steroids have been shown to be useful in a proportion of patients who deteriorated despite antibiotics and supportive treatment. SARS has a high morbidity (about 25% required intensive care) and fatality (9.6%). A high index of suspicion for the disease, isolation of patients, strict observation of infection control practices and compliance with use of personal protective equipment are necessary to prevent nosocomial infection. Contact tracing and quarantine are essential measures to prevent community spread of disease. Prevention of future outbreaks requires strengthening of infection control practices in hospitals, development of a rapid diagnostic test and a vaccine, and removal of any animal reservoir and environmental conditions that led to the spread of the disease.


title: Coronaviruses maintain viability despite dramatic rearrangements of the strictly conserved genome organization.

text: Despite their high frequency of RNA recombination, the plus-strand coronaviruses have a characteristic, strictly conserved genome organization with the essential genes occurring in the order 5'-polymerase (pol)-S-E-M-N-3'. We have investigated the significance of this remarkable conservation by rearrangement of the murine coronavirus genome through targeted recombination. Thus, viruses were prepared with the following gene order: 5'-pol-S-M-E-N-3', 5'-pol-S-N-E-M-3', 5'-pol-M-S-E-N-3', and 5'-pol-E-M-S-N-3'. All of these viruses were surprisingly viable, and most viruses replicated in cell culture with growth characteristics similar to those of the parental virus. The recombinant virus with the gene order 5'-pol-E-M-S-N-3' was also tested for the ability to replicate in the natural host, the mouse. The results indicate that the canonical coronavirus genome organization is not essential for replication in vitro and in vivo. Deliberate rearrangement of the viral genes may be useful in the generation of attenuated coronaviruses, which due to their reduced risk of generating viable viruses by recombination with circulating field viruses, would make safer vaccines.


title: [Electron microscopic demonstration of viruses in feces of dogs with diarrhea].

text: 4044 stool samples of dogs with diarrhoea were examined by electron microscopy. The samples were sent for routine diagnostics in the years 1988-1993. Over the examination period virus was detected in 32% of the samples. Parvovirus was diagnosed in 17.2% and coronavirus in 12.4% of the cases. The number of parvovirus-positive samples was lower than in former years, whereas the number of coronavirus-positive samples was higher. Other virus particles (paramyxo-, picorna-, calici- and astrovirus or morphologically similar particles as well as rota- and adenovirus) were altogether detected in 2.5% of the samples. This detection rate corresponded to the results of former years. The majority of parvovirus-positive samples (80.7%) was found in animals aged between six weeks and six months. Of the coronavirus-positive samples 56.5% were detected in dogs older than six months of age and 42.5% in animals between six weeks and six months. In puppies up to six weeks viruses were only detected infrequently (parvovirus 4.7%, coronavirus 0.9%).


title: Severe acute respiratory syndrome coronavirus ORF6 antagonizes STAT1 function by sequestering nuclear import factors on the rough endoplasmic reticulum/Golgi membrane.

text: The host innate immune response is an important deterrent of severe viral infection in humans and animals. Nuclear import factors function as key gatekeepers that regulate the transport of innate immune regulatory cargo to the nucleus of cells to activate the antiviral response. Using severe acute respiratory syndrome coronavirus (SARS-CoV) as a model, we demonstrate that SARS-COV ORF6 protein is localized to the endoplasmic reticulum (ER)/Golgi membrane in infected cells, where it binds to and disrupts nuclear import complex formation by tethering karyopherin alpha 2 and karyopherin beta 1 to the membrane. Retention of import factors at the ER/Golgi membrane leads to a loss of STAT1 transport into the nucleus in response to interferon signaling, thus blocking the expression of STAT1-activated genes that establish an antiviral state. We mapped the region of ORF6, which binds karyopherin alpha 2, to the C terminus of ORF6 and show that mutations in the C terminus no longer bind karyopherin alpha 2 or block the nuclear import of STAT1. We also show that N-terminal deletions of karyopherin alpha 2 that no longer bind to karyopherin beta 1 still retain ORF6 binding activity but no longer block STAT1 nuclear import. Recombinant SARS-CoV lacking ORF6 did not tether karyopherin alpha 2 to the ER/Golgi membrane and allowed the import of the STAT1 complex into the nucleus. We discuss the likely implications of these data on SARS-CoV replication and pathogenesis.


title: A critical intersection: human rights, public health nursing, and nursing ethics.

text: Public health nurses must make moral decisions regarding practice in complex situations fraught with competing moral claims. While nurses often frame practice decisions within the context of ethical theory, consideration of human rights perspectives is more recent. Basic concepts of nursing and public health ethics and of human rights, in relationship to public health, will be discussed and related to the practice of public health nursing. Intersections of human rights, ethics, and public health nursing practice will be discussed in light of the assertion of health as a human right and described using the issues of HIV/AIDS and genetics/genomics.


title: Bugs Are Not to Be Silenced: Small RNA Pathways and Antiviral Responses in Insects.

text: Like every other organism on Earth, insects are infected with viruses, and they rely on RNA interference (RNAi) mechanisms to circumvent viral infections. A remarkable characteristic of RNAi is that it is both broadly acting, because it is triggered by double-stranded RNA molecules derived from virtually any virus, and extremely specific, because it targets only the particular viral sequence that initiated the process. Reviews covering the different facets of the RNAi antiviral immune response in insects have been published elsewhere. In this review, we build a framework to guide future investigation. We focus on the remaining questions and avenues of research that need to be addressed to move the field forward, including issues such as the activity of viral suppressors of RNAi, comparative genomics, the development of detailed maps of the subcellular localization of viral replication complexes with the RNAi machinery, and the regulation of the antiviral RNAi response.


title: Analysis of deaths during the severe acute respiratory syndrome (SARS) epidemic in Singapore: challenges in determining a SARS diagnosis.

text: CONTEXT An outbreak of severe acute respiratory syndrome (SARS), an infectious disease attributed to a novel coronavirus, occurred in Singapore during the first quarter of 2003 and led to 204 patients with diagnosed illnesses and 26 deaths by May 2, 2003. Twenty-one percent of these patients required admission to the medical intensive care unit. During this period, the Center for Forensic Medicine, Health Sciences Authority, Singapore, performed a total of 14 postmortem examinations for probable and suspected SARS. Of these, a total of 8 were later confirmed as SARS infections. OBJECTIVE Our series documents the difficulties encountered at autopsy during the initial phases of the SARS epidemic, when the pattern of infection and definitive diagnostic laboratory criteria were yet to be established. DESIGN Autopsies were performed by pathologists affiliated with the Center for Forensic Medicine, Health Sciences Authority, Singapore. Tissue was accessed and read at the Tan Tock Seng Hospital, Singapore, and at the Armed Forces Institute of Pathology, Washington, DC. Autopsy tissue was submitted to the Virology Department, Singapore General Hospital, for analysis, and in situ hybridization for the SARS coronavirus was carried out at the National Institute of Infectious Diseases, Tokyo, Japan. RESULTS Thirteen of 14 patients showed features of diffuse alveolar damage. In 8 patients, no precipitating etiology was identified, and in all of these patients, we now have laboratory confirmation of coronavirus infection. Two of the 8 patients presented at autopsy as sudden unexpected deaths, while the remaining 6 patients had been hospitalized with varying lengths of stay in the intensive care unit. In 3 patients, including the 2 sudden unexpected deaths, in situ hybridization showed the presence of virally infected cells within the lung. In 4 of the 8 SARS patients, pulmonary thromboemboli were also recognized on gross examination, while one patient had marantic cardiac valvular vegetations. CONCLUSIONS It is unfortunate that the term atypical pneumonia has been used in conjunction with SARS. Although nonspecific by itself, the term does not accurately reflect the underlying dangers of viral pneumonia, which may progress rapidly to acute respiratory distress syndrome. We observed that the clinical spectrum of disease as seen in our autopsy series included sudden deaths. This is a worrisome finding that illustrates that viral diseases will have a spectrum of clinical presentations and that the diagnoses made for such patients must incorporate laboratory as well as clinical data.


title: Binding effects of concanavalin A on a coronavirus.

text: Concanavalin A, a phytagglutinin, binds to the envelope of hemagglutinating encephalomyelitis virus, a Coronavirus. Concanavalin A treated virus suspensions lose their hemagglutination properties and there is a transient interference with infectivity. Electron micrographs show the Concanavalin A as a granular deposit adhering to the viral envelope and there is aggregation of the virus. Concanavalin A does not bind to virions stripped of their envelopes.


title: Diagnosis of avian viral diseass by electron microscopy.

text: Clinical material from avian species was examined directly by electron microscopy for the presence of viruses. Mycoplasma-like and coronavirus-like particles were found in chicken feces. These particles did not appear to be associated with disease and were not propagated in the laboratory. Infectious bursal disease virus was readily detected in impression smears of bursas from experimentally infected birds. Poxviruses were demonstrated in smears made from canarypox lesions. Difficulty in distinguishing intact particles of Newcastle disease virus from mycoplasmas and orthomyxoviruses was resolved by treating viral preparations with deoxycholate. After treatment, Newcastle disease virus was lysed, rendering the nucleocapsid visible, whereas influenza virus was mainly unaffected. Viral particles that were recognized only with difficulty by direct elecron microscopic examination were more easily identified using immunoelectron microscopy.


title: In vitro and in ovo expression of chicken gamma interferon by a defective RNA of avian coronavirus infectious bronchitis virus.

text: Coronavirus defective RNAs (D-RNAs) have been used for site-directed mutagenesis of coronavirus genomes and for expression of heterologous genes. D-RNA CD-61 derived from the avian coronavirus infectious bronchitis virus (IBV) was used as an RNA vector for the expression of chicken gamma interferon (chIFN-gamma). D-RNAs expressing chIFN-gamma were shown to be capable of rescue, replication, and packaging into virions in a helper virus-dependent system following electroporation of in vitro-derived T7 RNA transcripts into IBV-infected cells. Secreted chIFN-gamma, under the control of an IBV transcription-associated sequence derived from gene 5 of the Beaudette strain, was expressed from two different positions within CD-61 and shown to be biologically active. In addition, following infection of 10-day-old chicken embryos with IBV containing D-RNAs expressing chIFN-gamma, the allantoic fluid was shown to contain biologically active chIFN-gamma, demonstrating that IBV D-RNAs can express heterologous genes in vivo.


title: Spontaneous pneumomediastinum in a scuba diver.

text: Pneumomediastinum usually occurs following an airleak from the lungs, or from a perforated oesophagus. We report on a 30-year-old man who developed pneumomediastinum after scuba diving. The patient presented with acute onset of throat pain, odynophagia, and hoarseness of voice. The literature is reviewed for this condition.


title: Effect of pH and temperature on the infectivity of human coronavirus 229E.

text: The stability of human coronavirus 229E infectivity was maximum at pH 6.0 when incubated at either 4 or 33 degrees C. However, the influence of pH was more pronounced at 33 degrees C. Viral infectivity was completely lost after a 14-day incubation period at 22, 33, or 37 degrees C but remained relatively constant at 4 degrees C for the same length of time. Finally, the infectious titer did not show any significant reduction when subjected to 25 cycles of thawing and freezing. These studies will contribute to optimize virus growth and storage conditions, which will facilitate the molecular characterization of this important pathogen.


title: A U-turn motif-containing stem-loop in the coronavirus 5' untranslated region plays a functional role in replication.

text: The 5' untranslated region (UTR) of the mouse hepatitis virus (MHV) genome contains cis-acting sequences necessary for transcription and replication. A consensus secondary structural model of the 5' 140 nucleotides of the 5' UTRs of nine coronaviruses (CoVs) derived from all three major CoV groups is presented and characterized by three major stem-loops, SL1, SL2, and SL4. NMR spectroscopy provides structural support for SL1 and SL2 in three group 2 CoVs, including MHV, BCoV, and HCoV-OC43. SL2 is conserved in all CoVs, typically containing a pentaloop (C47-U48-U49-G50-U51 in MHV) stacked on a 5 base-pair stem, with some sequences containing an additional U 3' to U51; SL2 therefore possesses sequence features consistent with a U-turn-like conformation. The imino protons of U48 in the wild-type RNA, and G48 in the U48G SL2 mutant RNA, are significantly protected from exchange with solvent, consistent with a hydrogen bonding interaction critical to the hairpin loop architecture. SL2 is required for MHV replication; MHV genomes containing point substitutions predicted to perturb the SL2 structure (U48C, U48A) were not viable, while those that maintain the structure (U48G and U49A) were viable. The U48C MHV mutant supports both positive- and negative-sense genome-sized RNA synthesis, but fails to direct the synthesis of positive- or negative-sense subgenomic RNAs. These data support the existence of the SL2 in our models, and further suggest a critical role in coronavirus replication.


SARS and the effect on nurse education in Singapore.


title: Stress and psychological impact on SARS patients during the outbreak.

text: OBJECTIVE To examine stress and psychological impact in severe acute respiratory syndrome (SARS) patients during the 2003 outbreak. SARS is a novel, highly infectious pneumonia, and its psychological impact is still unclear. METHOD At the peak of the outbreak, SARS patients (n = 79) and healthy control subjects (n = 145) completed the Perceived Stress Scale (PSS) and documented a range of psychological responses. Groups were balanced for age, sex, education, and living circumstances. RESULTS Stress was significantly higher in SARS patients than in healthy control subjects. Stress correlated significantly with negative psychological effects. Of SARS patients, 39% (n = 30) were infected health care workers; these individuals reported significantly more fatigue and worries about health than did other patients. Of patients, 25% (n = 20) requested psychological follow-up. CONCLUSIONS General stress and negative psychological effects are increased in SARS patients, particularly among infected health care workers. This may increase the risk of mood and stress-related disorders. Functional impairment is apparent in the postrecovery phase.


title: The coronavirus spike protein is a class I virus fusion protein: structural and functional characterization of the fusion core complex.

text: Coronavirus entry is mediated by the viral spike (S) glycoprotein. The 180-kDa oligomeric S protein of the murine coronavirus mouse hepatitis virus strain A59 is posttranslationally cleaved into an S1 receptor binding unit and an S2 membrane fusion unit. The latter is thought to contain an internal fusion peptide and has two 4,3 hydrophobic (heptad) repeat regions designated HR1 and HR2. HR2 is located close to the membrane anchor, and HR1 is some 170 amino acids (aa) upstream of it. Heptad repeat (HR) regions are found in fusion proteins of many different viruses and form an important characteristic of class I viral fusion proteins. We investigated the role of these regions in coronavirus membrane fusion. Peptides HR1 (96 aa) and HR2 (39 aa), corresponding to the HR1 and HR2 regions, were produced in Escherichia coli. When mixed together, the two peptides were found to assemble into an extremely stable oligomeric complex. Both on their own and within the complex, the peptides were highly alpha helical. Electron microscopic analysis of the complex revealed a rod-like structure approximately 14.5 nm in length. Limited proteolysis in combination with mass spectrometry indicated that HR1 and HR2 occur in the complex in an antiparallel fashion. In the native protein, such a conformation would bring the proposed fusion peptide, located in the N-terminal domain of HR1, and the transmembrane anchor into close proximity. Using biological assays, the HR2 peptide was shown to be a potent inhibitor of virus entry into the cell, as well as of cell-cell fusion. Both biochemical and functional data show that the coronavirus spike protein is a class I viral fusion protein.


title: Induction and enhancement of feline infectious peritonitis by canine coronavirus.

text: Preexisting antibody to feline infectious peritonitis virus (FIPV) causes acceleration and enhancement of disease on subsequent infection of cats with FIPV. Other workers have shown that canine coronavirus (CCV) can infect cats subclinically, but have found no evidence of enhancement of, or protection against, subsequent FIPV infection. With various isolates of CCV, we determined that 1 strain of CCV can induce transient mild diarrhea in cats and, furthermore, that previous infection with CCV causes acceleration and enhancement of subsequent infection with FIPV. In addition, sequential inoculation of cats with another strain of CCV caused lesions indistinguishable from those of FIP, without exposure at any time to FIPV.


title: Antibody-dependent enhancement occurs upon re-infection with the identical serotype virus in feline infectious peritonitis virus infection.

text: Feline infectious peritonitis virus (FIPV) is classified into serotype I and serotype II according to the amino acid sequence of its spike(S) protein. Antibody dependent enhancement (ADE) of macrophage infection occurs in the presence of antibodies to FIPV S protein, and a close relationship between ADE and neutralizing epitopes has been reported. The importance of differences in FIPV serotype on the induction of ADE remains unclear. In this study, we investigated whether the same or different serotype of FIPV induces ADE in cats. Specific pathogen-free cats were passively immunized with anti-type I or II FIPV antibodies, and we investigated the induction of ADE following subcutaneous inoculation with type I FIPV. Inoculation using FIPV serotype I enhanced the onset of FIP in cats passively immunized with FIPV serotype I-specific antibodies but not in those passively immunized with antibodies to FIPV serotype II. These data suggest that re-infection with the same serotype induces ADE in cats infected with FIPV.


title: Australia's notifiable disease status, 2014: Annual report of the National Notifiable Diseases Surveillance System.

text: In 2014, 69 diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 275,581 notifications of communicable diseases to the National Notifiable Diseases Surveillance System, an increase of 22% on the number of notifications in 2013. In 2014, the most frequently notified diseases were sexually transmissible infections (105,719 notifications, 38% of total notifications), vaccine preventable diseases (101,400 notifications, 37% of total notifications), and gastrointestinal diseases (40,367 notifications, 15% of total notifications). There were 17,411 notifications of bloodborne diseases; 8,125 notifications of vectorborne diseases; 1,942 notifications of other bacterial infections; 615 notifications of zoonoses and 2 notifications of quarantinable diseases.


docid: pgzsbowz

title: Laboratory findings associated with abomasal ulcers/tympany in range calves.

text: The etiology of abomasal ulcers/tympany was investigated in 48 animals from 36 ranches in Wyoming and Nebraska. Results indicate that subclinical trace mineral deficiencies of copper and/or selenium exist in the range cattle in west central Nebraska and Wyoming. Etiological agents most frequently incriminated by bacteriologic cultures and/or histopathic examination were Clostridium perfringens and Campylobacter species. Histopathologic evaluation of abomasums revealed 31 of 38 cases contained abundant gram-positive bacteria associated with the damaged abomasal mucosa. Campylobacter-like organisms were demonstrated in 9 of 38 cases using the modified Dieterle stain. Clostridium perfringens was isolated in 14 of 38 cases, and Campylobacter jejuni was recovered from 5 of 38 cases.


title: The transmissible gastroenteritis coronavirus contains a spherical core shell consisting of M and N proteins.

text: Coronaviruses are enveloped RNA viruses involved in a variety of pathologies that affect animals and humans. Existing structural models of these viruses propose a helical nucleocapsid under the virion envelope as the unique internal structure. In the present work, we have analyzed the structure of the transmissible gastroenteritis coronavirus. The definition of its organization supports a new structural model for coronaviruses, since a spherical, probably icosahedral, internal core has been characterized. Disruption of these cores induces the release of N-protein-containing helical nucleocapsids. Immunogold mapping and protein analysis of purified cores showed that they consist of M and N proteins, M being the main core shell component. This surprising finding, together with the fact that M protein molecules are also located in the virion envelope, indicates that a reconsideration of the assembly and maturation of coronaviruses, as well as a study of potential M-protein subclasses, is needed.


title: Involvement of the nucleolus in plant virus systemic infection.

text: The nucleolus is a prominent subnuclear domain and is classically regarded as the site of transcription of rRNA, processing of the precursor rRNAs and biogenesis of pre-ribosomal particles. In addition to these traditionally recognized activities, the nucleolus also participates in many other aspects of cell function. The umbravirus-encoded ORF3 protein is a multifunctional RNA-binding protein involved in long-distance RNA movement, and protection of viral RNA from RNase attack, including possibly small interfering RNA-guided RNA silencing. In addition to its presence in cytoplasmic ribonucleoprotein particles containing viral RNA, the umbraviral ORF3 protein accumulates in nuclei, preferentially targeting nucleoli. The ORF3 protein domains involved in the localization of the protein to the nucleolus were identified. Functional analysis of the mutants revealed the correlation between the ORF3 protein nucleolar localization and its ability to form the cytoplasmic ribonucleoprotein particles and transport viral RNA long distances via the phloem. Possible mechanisms of the nucleolar involvement in systemic virus infection are discussed.


docid: tksjoxhp

title: Diffuse muscle pain with quetiapine.


title: Bovine cryptosporidiosis: a transmission and scanning electron microscopic study of some stages in the life cycle and of the host-parasite relationship.

text: Transmission and scanning electron microscopy of the ileal mucosae from 12 calves infected with Cryptosporidium sp. showed cryptosporidia free in the lumen and attached to epithelium. The attached parasites were interpreted to be extracellular and adherent to the microvillous border of epithelial cells. Stages of the organism included crescentic-free merozoites, trophozoites, schizonts, gametes and oocysts. Attached parasites were detected chiefly at villous tips and all stages were present on a single villus. Attachment sites were characterized by absence or disintegration of microvilli, disorganization of the terminal web and development of a specialized attachment zone. There were increased numbers of lysosomes and irregularities in the nuclear membrane of parasitized epithelial cells. It was concluded that cryptosporidia exist in bovine intestine as extracellular parasites and cause epithelial changes that in turn probably cause or contribute to diarrheal disease.


title: [Bad bats?].

text: For many centuries, man is fascinated by bats, the only flying mammals. Probably because of their particular immune system, bats can be considered an important reservoir for new emerging viral diseases like SARS-Coronavirus, Marburg fever, Ebola fever and Nipah virus encephalitis. During closer contact, they can transmit rabies and probably other nonviral infectious diseases. Bats get closer to man due to ecological modifications like deforestation, so that transmission of new infectious agents might provoke dramatic epidemics.


Viral lower respiratory tract infection in infants and young children.


docid: txjngglc

title: Tuberculosis control in RI: maintaining control efforts in the context of declining incidence and funding for tuberculosis programs.


title: [Construction of recombinant canine adenovirus type 2 expressing Canine coronavirus spike glycoprotein and its immunogenicity].

text: In order to construct a recombinant Canine adenovirus type 2 (CAV-2) expressing the spike glycoprotein of Canine coronavirus (CCV), the S1 gene fragment of CCV strain DXMV, encoding major antigenic region A, B, C and D of S protein, was amplified by RT-PCR and cloned into pVAX1 vector. The complete S1 expression cassette was subcloned into the shuttle vector pVAXE3, then further cloned into the backbone vector pPoly2-CAV2 containing complete genome of CAV-2. To gain the recombinant Canine adenovirus, the recombinant plasmid pCAV-2-CCV-S1 was linearized by Cla I/Asc I to release recombinant genome, and then transfected into MDCK cell. The recombinant virus CAV-2-S1 was gained through 4 passages in MDCK, which showed classical CPE of CAV-2. The expressed S1 protein of CCV, which was identified by RT-PCR and Western blot, can be specifically recognized by polyclonal antibody against CCV. The immunization in dogs indicated that the recombinant CAV-2 could effectively induce the specific antibodies against CCV and CAV.


The 'One Health' paradigm: Time for infectious diseases clinicians to take note?


title: Variations in the neutralizing and haemagglutination-inhibiting activities of five influenza A virus-specific IgGs and their antibody fragments.

text: Neutralization and haemagglutination-inhibition (HI) of a type A influenza virus by a panel of five monoclonal IgGs, their F(ab')2s, Fabs and Fabs+ anti-mouse Fab were compared. The MAbs were specific for antigenic sites A, B and D of the haemagglutinin. Activities of the IgGs varied by up to 6-fold on a molar basis, apart from the HI activity of HC58 which was > 100-fold lower. This was not due to low functional affinity as HC58 had the second highest value (nM) as determined by an equilibrium method with whole virions. Conversion to the F(ab')2 reduced neutralization and HI by only 2- to 6-fold, indicating that the Fc region had little involvement in these processes. However, all Fabs had low neutralization and HI activity compared with their IgGs, neutralization being reduced by 86 to > 1912-fold, and HI by 13 to > 69-fold. Although decreased, their affinities remained high, in the nM range. Neutralization and HI by three of the Fabs (HC2, HC3W and HC61) were restored by the addition of anti-Fab IgG; however, HC10 Fab+anti-Fab IgG still had no detectable neutralization activity but gave HI, and HC58 Fab+anti-Fab IgG had no detectable HI activity but neutralized to the same extent as its IgG. The different properties of the antibodies are discussed in the light of their known mechanisms of action: HI by steric blocking of attachment of virus to the red cell receptor, and neutralization by the inhibition of post-attachment events (HC2, HC10 and HC61). The data demonstrate just how variable are the antiviral properties of individual IgGs.


Kawasaki disease.


Coronavirus infections in working adults. Eight-year study with 229 E and OC 43.


title: Exposure to feline and canine pathogens in bobcats and gray foxes in urban and rural zones of a national park in California.

text: Exposure of bobcats (Lynx rufus) and gray foxes (Urocyon cinereoargenteus) to a range of common canine and feline pathogens was assessed in urban and rural zones of Golden Gate National Recreation Area, a National Park in the San Francisco Bay Area, (California, USA) from 1992 to 1995. Testing included serology for canine distemper virus, canine parvovirus (CPV), canine adenovirus, Leptospira interrogans, feline calicivirus (FCV), feline panleukopenia virus, feline herpesvirus, feline enteric coronavirus (FECV), feline immunodeficiency virus, feline leukemia virus, Toxoplasma gondii, and Bartonella henselae. Testing was also performed for Dirofilaria immitis. Significantly more gray foxes were seropositive for CPV in the urban zone than in the rural zone. In addition, radio-tracking of gray foxes in the rural zone indicated that all three of the rural CPV-seropositive foxes had traveled into adjoining small towns, whereas only one of the 11 seronegative animals had done so. Significantly more bobcats were seropositive for FCV in the rural zone than in the urban zone. Individual bobcats with positive FCV antibody titers had patterns of movement that intercepted park inholdings where domestic cats lived. Bobcat samples were seronegative for all five of the other viral feline pathogens, with the exception of a FECV-seropositive bobcat. High seroprevalence was detected for B. henselae and T. gondii in both zones. Variation in the seroprevalence for different pathogens might be related to differences in the exposure of bobcats and foxes to domestic animals: in the urban zone, gray foxes were located in residential areas outside the park, whereas bobcats were not. Although for most of the pathogens examined there was no relationship between urbanization and exposure, our results for CPV in foxes and FCV in bobcats indicated that proximity to urban areas or contact with humans can increase the risk of disease exposure for wild carnivore populations. Combining behavioral information from radio-tracking with data on pathogen exposure or disease incidence can provide valuable insights into the ecology of wildlife disease that might be missed with broad-scale, population-level comparisons alone.


title: Murine coronavirus replication-induced p38 mitogen-activated protein kinase activation promotes interleukin-6 production and virus replication in cultured cells.

text: Analyses of mitogen-activated protein kinases (MAPKs) in a mouse hepatitis virus (MHV)-infected macrophage-derived J774.1 cell line showed activation of two MAPKs, p38 MAPK and c-Jun N-terminal kinase (JNK), but not of extracellular signal-regulated kinase (ERK). Activation of MAPKs was evident by 6 h postinfection. However, UV-irradiated MHV failed to activate MAPKs, which demonstrated that MHV replication was necessary for their activation. Several other MHV-permissive cell lines also showed activation of both p38 MAPK and JNK, which indicated that the MHV-induced stress-kinase activation was not restricted to any particular cell type. The upstream kinase responsible for activating MHV-induced p38 MAPK was the MAPK kinase 3. Experiments with a specific inhibitor of p38 MAPK, SB 203580, demonstrated that MHV-induced p38 MAPK activation resulted in the accumulation of interleukin-6 (IL-6) mRNAs and an increase in the production of IL-6, regardless of MHV-induced general host protein synthesis inhibition. Furthermore, MHV production was suppressed in SB 203580-treated cells, demonstrating that activated p38 MAPK played a role in MHV replication. The reduced MHV production in SB 203580-treated cells was, at least in part, due to a decrease in virus-specific protein synthesis and virus-specific mRNA accumulation. Interestingly, there was a transient increase in the amount of phosphorylation of the translation initiation factor 4E (eIF4E) in infected cells, and this eIF4E phosphorylation was p38 MAPK dependent; it is known that phosphorylated eIF4E enhances translation rates of cap-containing mRNAs. Furthermore, the upstream kinase responsible for eIF4E phosphorylation, MAPK-interacting kinase 1, was also phosphorylated and activated in response to MHV infection. Our data suggested that host cells, in response to MHV replication, activated p38 MAPK, which subsequently phosphorylated eIF4E to efficiently translate certain host proteins, including IL-6, during virus-induced severe host protein synthesis inhibition. MHV utilized this p38 MAPK-dependent increase in eIF4E phosphorylation to promote virus-specific protein synthesis and subsequent progeny virus production. Enhancement of virus-specific protein synthesis through virus-induced eIF4E activation has not been reported in any other viruses.


title: RNase L-independent specific 28S rRNA cleavage in murine coronavirus-infected cells.

text: We characterized a novel 28S rRNA cleavage in cells infected with the murine coronavirus mouse hepatitis virus (MHV). The 28S rRNA cleavage occurred as early as 4 h postinfection (p.i.) in MHV-infected DBT cells, with the appearance of subsequent cleavage products and a decrease in the amount of intact 28S rRNA with increasing times of infection; almost all of the intact 28S rRNA disappeared by 24 h p.i. In contrast, no specific 18S rRNA cleavage was detected in infected cells. MHV-induced 28S rRNA cleavage was detected in all MHV-susceptible cell lines and all MHV strains tested. MHV replication was required for the 28S rRNA cleavage, and mature cytoplasmic 28S rRNA underwent cleavage. In certain combination of cells and viruses, pretreatment of virus-infected cells with interferon activates a cellular endoribonuclease, RNase L, that causes rRNA degradation. No interferon was detected in the inoculum used for MHV infection. Addition of anti-interferon antibody to MHV-infected cells did not inhibit 28S rRNA cleavage. Furthermore, 28S rRNA cleavage occurred in an MHV-infected mouse embryonic fibroblast cell line derived from RNase L knockout mice. Thus, MHV-induced 28S rRNA cleavage was independent of the activation of RNase L. MHV-induced 28S rRNA cleavage was also different from apoptosis-related rRNA degradation, which usually occurs concomitantly with DNA fragmentation. In MHV-infected 17Cl-1 cells, 28S rRNA cleavage preceded DNA fragmentation by at least 18 h. Blockage of apoptosis in MHV-infected 17Cl-1 cells by treatment with a caspase inhibitor did not block 28S rRNA cleavage. Furthermore, MHV-induced 28S rRNA cleavage occurred in MHV-infected DBT cells that do not show apoptotic signs, including activation of caspase-3 and DNA fragmentation. Thus, MHV-induced 28S rRNA cleavage appeared to differ from any rRNA degradation mechanism described previously.


title: Malaria acquired in Haiti - 2010.

text: On January 12, 2010, a 7.0 magnitude earthquake struck Haiti, which borders the Dominican Republic on the island of Hispaniola. The earthquake's epicenter was 10 miles west of the Haiti capital city of Port-au-Prince (estimated population: 2 million). According to the Haitian government, approximately 200,000 persons were killed, and 500,000 were left homeless. Malaria caused by Plasmodium falciparum infection is endemic in Haiti, and the principal mosquito vector is Anopheles albimanus, which frequently bites outdoors. Thus, displaced persons living outdoors or in temporary shelters and thousands of emergency responders in Haiti are at substantial risk for malaria. During January 12-February 25, CDC received reports of 11 laboratory-confirmed cases of P. falciparum malaria acquired in Haiti. Patients included seven U.S. residents who were emergency responders, three Haitian residents, and one U.S. traveler. This report summarizes the 11 cases and provides chemoprophylactic and additional preventive recommendations to minimize the risk for acquiring malaria for persons traveling to Haiti.


title: Specialty and sex as predictors of depression in dentists.

text: BACKGROUND Stress, burnout, substance abuse and suicide among dentists have been studied, yet no study in the United States has specifically addressed depression in e dentists. The objective of the authors' study was to determine if sex and dental specialty were correlated with depression in dentists. METHODS The authors conducted a survey of a sample of dentists chosen randomly from the American Dental Association's mailing list of member dentists. The survey, stratified by sex and specialty, resulted in 560 responses, for a 53 percent response rate. The authors used the Zung Self-Rating Depression Scale to measure depression. The authors examined the respondents' sex, age, number of children, marital status, specialty, practice type, location of practice, years in practice and hours worked per week. RESULTS The rate of depression in the overall sample was 9 percent. Sex was associated with depression (P < .001), but specialty was not. However, multiple regression analysis found that sex was significantly related to depression in only two specialties: periodontics and pediatric dentistry. Overall, the regression model explained an unimpressive 6 percent of the variance in depression scores. The most important finding of the study was that only 15 percent of depressed dentists were receiving treatment. CONCLUSIONS The survey results showed that only female pediatric dentists and periodontists were more depressed than their male counterparts. None of the other variables studied contributed significantly to the understanding of depression in dentists. Depressed dentists, like other depressed people, tend not to seek treatment. CLINICAL IMPLICATIONS Depression and serious depression occur among dentists, and much of it is untreated. Because depression is harmful to dentists and raises quality-of-care issues, they should be educated to help them recognize depression and encouraged to seek treatment.


title: Polarized entry and release of Junin virus, a New World arenavirus.

text: Junin virus (JUNV), the causative agent of Argentine haemorrhagic fever, is a human pathogen that naturally enters the body through the epithelial cells of the respiratory and digestive tracts. The interaction of JUNV with two types of polarized epithelial cultures, Vero C1008 and A549, was investigated. Radioactive virus-binding assays showed that JUNV infects polarized lines preferentially through the apical surface. High-level expression of viral nucleoprotein was detected in polarized cell lines infected through the apical domain. Virus production from apical media was about 100-fold higher than that found into the basolateral medium. Confocal-immunofluorescence analysis revealed high-level expression of glycoprotein at the apical-membrane surface. Disruption of the microtubule network by colchicine impaired JUNV vectorial release. This is the first study to analyse the interaction between a member of the virus family Arenaviridae and polarized epithelial cells, showing preferential entry and release from the apical plasma membrane.


title: Episodic evolution mediates interspecies transfer of a murine coronavirus.

text: Molecular mechanisms permitting the establishment and dissemination of a virus within a newly adopted host species are poorly understood. Mouse hepatitis virus (MHV) strains (MHV-A59, MHV-JHM, and MHV-A59/MHV-JHM) were passaged in mixed cultures containing progressively increasing concentrations of nonpermissive Syrian baby hamster kidney (BHK) cells and decreasing concentrations of permissive murine DBT cells. From MHV-A59/MHV-JHM mixed infection, variant viruses (MHV-H1 and MHV-H2) which replicated efficiently in BHK cells were isolated. Under identical treatment conditions, the parental MHV-A59 or MHV-JHM strains failed to produce infectious virus or transcribe detectable levels of viral RNA or protein. The MHV-H isolates were polytrophic, replicating efficiently in normally nonpermissive Syrian hamster smooth muscle (DDT-1), Chinese hamster ovary (CHO), human adenocarcinoma (HRT), primate kidney (Vero), and murine 17Cl-1 cell lines. Little if any virus replication was detected in feline kidney (CRFK) and porcine testicular (ST) cell lines. The variant virus, MHV-H2, transcribed seven mRNAs equivalent in relative abundance and size to those synthesized by the parental virus strains. MHV-H2 was an RNA recombinant virus containing a crossover site in the S glycoprotein gene. At the molecular level, episodic evolution and positive Darwinian natural selection were apparent within the MHV-H2 S and HE glycoprotein genes. These findings differ from the hypothesis that neutral changes are the predominant feature of molecular evolution and argue that changing ecologies actuate episodic evolution in the MHV spike glycoprotein genes that govern interspecies transfer and spread into alternative hosts.


title: Examination of animal and zoonotic pathogens using microarrays.

text: The advancement in functional genomics, such as DNA microarrays along with the genome availability of important pathogens as well as of human and livestock species has allowed scientists to study the expression of thousands of genes in a single step. In the past decade, DNA arrays have been employed to study infectious processes of pathogens, in diagnostics, and to study host-pathogen interactions. The generation of enormous data sets by microarray experiments also stimulated the growth of a new generation of analytical software. The information provided by microarray experiments has been useful in generating new hypotheses for future research. The concept of DNA array technology has been utilized in the development of novel diagnostic methods. This review highlights the application of microarrays in the field of veterinary research.


title: Duration of RT-PCR positivity in severe acute respiratory syndrome.

text: Severe acute respiratory syndrome (SARS) is a highly infectious respiratory infection with a high mortality. The duration of infectivity is unknown. The RT-PCR positivity for SARS-associated coronavirus (SARS-CoV) was followed in 45 virologically confirmed SARS patients. Serial RT-PCRs for SARS-CoV were performed in the nasopharyngeal aspirate, stool and urine of 45 SARS patients who survived until discharge. All patients had at least one site that was positive for SARS-CoV on presentation. Time to RT-PCR conversion was studied in all patients. There were 15 males (33.3%) and 30 females (66.7%), with a mean+/- SD age of 40.7+/-14.7 yrs. The median (range) time of RT-PCR conversion was 30 days (2-81). On discharge from the hospital, 18 (40%) remained RT-PCR positive in at least one site. For patients with positive RT-PCR on discharge, the median (range) time to RT-PCR conversion after discharge was 13 days (2-60). A significant proportion of severe acute respiratory syndrome patients remained RT-PCR positive for severe acute respiratory syndrome-associated coronavirus for a substantial duration after discharge. The clinical significance is unknown and this finding merits further study. It is prudent to advise patients to adhere to strict personal hygiene on discharge until RT-PCR becomes negative.


docid: nvkrggdy

title: Experimental infection with Neospora caninum in pregnant bitches.

text: In this study, transplacental transmission of Neospora caninum in bitches at different stages of pregnancy was evaluated. Three bitches were inoculated in the 3rd week and three in the 6th week of gestation with 10(8) tachyzoites of N. caninum (Nc-1 strain). All the infected bitches and at least one of their offspring presented anti-N. caninum antibodies according to the indirect fluorescent antibody test (IFAT > 400). The pups and their mothers were sacrificed and tissues from the central nervous system (CNS), popliteal lymph nodes, skeletal muscle, brain, lungs, heart and liver were analyzed for the presence of N. caninum using the nested polymerase chain reaction (nested PCR), restriction fragment length polymorphism (RFLP) and immunohistochemistry (IHC). The parasite was found in the pups in lymph node, CNS, heart and liver tissues using nested PCR. There was no difference in perinatal mortality between the offspring from bitches infected in the 3rd week of gestation (60%) and in the 6th week (53.8%).


title: Specific detection by real-time reverse-transcription PCR assays of a novel avian influenza A(H7N9) strain associated with human spillover infections in China.

text: In response to a recent outbreak in China, detection assays for a novel avian influenza A(H7N9) virus need to be implemented in a large number of public health laboratories. Here we present real-time reverse-transcription polymerase chain reaction (RT-PCR) assays for specific detection of this virus, along with clinical validation data and biologically-safe positive controls.


title: Simple enzymatic means to neutralize DNA contamination in nucleic acid amplification.

text: Reverse transcription PCR (RT-PCR) is prone to false positives when contaminating DNA molecules are present at the start of a reaction. Contaminants that derive from earlier work using a given primer pair (carryover PCR products) are of particular concern when those primers are used routinely, as in clinical diagnostics or environmental monitoring. In addition, contamination by genomic DNA can significantly interfere with quantitative and qualitative analysis of RNAs by RT-PCR. Here we describe contaminant restriction (ConR), a method that can be used to neutralize carryover and genomic DNA contamination in RT-PCR studies. Restriction enzymes (REs) added to the amplification cocktail cleave contaminant DNA molecules while sparing the intended target nucleic acid. Restriction, reverse transcription, and amplification steps all take place in the same sealed vessel, thus avoiding any danger of recontamination. ConR eliminates carryover contamination in PCR without compromising target sequence amplification. Because the method is effective against both genomic and carryover contamination, it can be employed routinely in one-step RT-PCR, whatever the RNA target or the nature of the potential DNA contaminant. A variation of this decontamination method, amplicon primer site restriction (APSR), is effective specifically against carryover contamination. APSR, unlike ConR, can be applied during PCR-based amplification of DNA target molecules.


title: Epidemiology of respiratory infections in young children: insights from the new vaccine surveillance network.

text: BACKGROUND The New Vaccine Surveillance Network, funded by the Centers for Disease Control and Prevention, was established to provide longitudinal data to help measure the impact of vaccines that decrease the burden of acute respiratory illness in children younger than 5 years of age. Currently 140,000 children younger than 5 years of age, nearly 1% of the U.S. population, are under surveillance in 3 urban counties, which include Nashville, TN, Rochester, NY, and Cincinnati, OH. Prospective, active, population-based surveillance of children hospitalized with respiratory symptoms or fever began in 2000, and outpatient surveillance began in 2002 in selected winter months. RESULTS During the first year of surveillance, the admission rate for acute respiratory illness/fever in children younger than 5 years of age in the surveillance areas was 180 per 10,000 children. In 61% of these hospitalizations, a respiratory virus was identified. Respiratory syncytial viruses, influenza viruses and parainfluenza viruses were identified in 30%, and other respiratory viruses were identified in 36%. Approximately one-third of children hospitalized had identified high risk conditions, primarily asthma (24%). About one-half of the children hospitalized were younger than 6 months of age. Polymerase chain reaction doubled the diagnostic yield of culture for respiratory syncytial viruses, influenza and parainfluenza virus combined. Preliminary data on influenza admissions during the 4 years indicated considerable variation in admission rates by season and site. Annually the mean admission rates during the study period were 43 per 10,000 children younger than 6 months of age, 9 per 10,000 children 6-23 months of age and 4 per 10,000 children 24-59 months of age. CONCLUSION These data provide ongoing surveillance of hospitalizations and other medically attended visits for respiratory viral illness in children younger than 5 years of age. Evaluation of influenza vaccine effectiveness, the epidemiology of respiratory viruses in children and the impact of the pediatric influenza vaccination program are in progress.


Vaccine safety: a case for synthetic vaccine formulations.


title: Specific interaction between coronavirus leader RNA and nucleocapsid protein.

text: Northwestern blot analysis in the presence of competitor RNA was used to examine the interaction between the mouse hepatitis virus (MHV) nucleocapsid protein (N) and virus-specific RNAs. Our accompanying article demonstrates that anti-N monoclonal antibodies immunoprecipitated all seven MHV-specific RNAs as well as the small leader-containing RNAs from infected cells. In this article we report that a Northwestern blotting protocol using radiolabeled viral RNAs in the presence of host cell competitor RNA can be used to demonstrate a high-affinity interaction between the MHV N protein and the virus-specific RNAs. Further, RNA probes prepared by in vitro transcription were used to define the sequences that participate in such high-affinity binding. A specific interaction occurs between the N protein and sequences contained with the leader RNA which is conserved at the 5' end of all MHV RNAs. We have further defined the binding sites to the area of nucleotides 56 to 65 at the 3' end of the leader RNA and suggest that this interaction may play an important role in the discontinuous nonprocessive RNA transcriptional process unique to coronaviruses.


title: Isolation of a coronavirus from a green-cheeked Amazon parrot (Amazon viridigenalis Cassin).

text: A virus (AV71/99) was isolated from a green-cheeked Amazon parrot by propagation and passage in both primary embryo liver cells derived from blue and yellow macaw (Ara ararauna) embryos and chicken embryo liver cells. Electron microscopic examination of cytopathic agents derived from both types of cell cultures suggested that it was a coronavirus. This was confirmed using a pan-coronavirus reverse transcriptase polymerase chain reaction that amplified part of gene 1 that encodes the RNA-dependent RNA polymerase. The deduced sequence of 66 amino acids had 66 to 74% amino acid identity with the corresponding sequence of coronaviruses in groups 1, 2 and 3. Several other oligonucleotide primer pairs that give PCR products corresponding to genes 3, 5, N and the 3'-untranslated region of infectious bronchitis virus, turkey coronavirus and pheasant coronavirus (all in group 3) failed to do so with RNA from the parrot coronavirus. This is the first demonstration of a coronavirus in a psittacine species.


title: Animal vaccination and the veterinary pharmaceutical industry.

text: The market for veterinary vaccines is spread across species but it is limited in size and the development of vaccines is becoming more complex and expensive. Vaccines are amongst the most effective means of preventing disease in both animals and humans. In many cases, diseases have been eradicated or their impact on animal health and welfare greatly reduced. It is an ethical responsibility to ensure the availability of a wide range of vaccines even where the market needs to be financially supported, as in the case of less common animal species and those with less common conditions (commonly referred to by the acronym MUMS: Minor Use and Minor Species). Mass slaughter is becoming unacceptable to society and we must move to a 'vaccinate to live' policy wherever possible. We need to use vaccines to avoid the high costs of disease and to enhance food safety. In developing vaccines, we need to minimise animal testing. In addition, we need to ensure that the public acceptthe use of vaccines in food-producing animals as a means of protecting the health and welfare of all animals. As we look to the future, vaccines will be vital to ensure our ability to provide more food to a growing global population. The European Technology Platform for Global Animal Health has a key role to play in identifying key research priorities.


title: Turtle-associated salmonellosis in humans--United States, 2006-2007.

text: Turtles and other reptiles are reservoirs of Salmonella and have long been a recognized source of Salmonella infection in humans. Small turtles have posed a particular danger to young children because these turtles might not be perceived as health hazards and can be handled like toys. Salmonella infections in children can be severe and can result in hospitalization and occasionally in death. The association between Salmonella infection in children and exposure to turtles led to a 1975 law prohibiting the sale or distribution of small turtles (i.e., those with a carapace of <4 inches in length) in the United States. That prohibition led to a substantial decline in human salmonellosis cases associated with turtles. However, because the prohibition is not fully enforced and contains exceptions (e.g., sales for educational purposes), human turtle-associated cases continue to occur. This report describes several recent cases of turtle-associated salmonellosis reported to CDC by state and local health departments since September 2006, including a fatal case in an infant. These cases illustrate that small turtles remain a source of human Salmonella infections. Although ongoing public education measures aimed at preventing reptile-acquired Salmonella infections are helpful, prohibiting the sale of small turtles likely remains the most effective public health action to prevent turtle-associated salmonellosis.


title: Human parechovirus infections and child myositis cases associated with genotype 3 in Osaka City, Japan, 2014.

text: Human parechovirus (HPeV) infects humans early in life and typically causes asymptomatic or mild diseases such as gastrointestinal and respiratory illness but sometimes leads to more serious consequences in neonates and young infants. In 2014, we detected HPeV from 38 patients by real-time reverse transcription-PCR in Osaka City, Japan, and 33 HPeV strains were genotyped based on their VP1 sequences. HPeV genotype 3 (HPeV-3) was the most prevalent and accounted for 22 cases (66.7%) followed by nine HPeV-1 (27.3%), one HPeV-2 (3.0%) and one HPeV-4 (3.0%). Phylogenetic analysis revealed that detected HPeV-3 strains were divided into three genetically distinct groups. One was characterized by a novel single amino acid deletion mutation at the N terminus of the 2A protein as well as the VP1 sequence, whereas the others were closely related to HPeV-3 strains detected in Japan in either 2008 or 2011. These HPeV-3 groups were detected from patients with various symptoms including three myositis cases. Recent papers have demonstrated that HPeV-3 was the aetiological agent for epidemic myalgia exclusively among adults from Yamagata Prefecture in Japan. Here, we provide clinical details and episodes of three myositis patients including an adult and two children in Osaka City, Japan. Our results suggest that HPeV-3 is a causative agent of myositis not only in adults but also in children.


docid: ivbiwjdx

title: Knowledge of severe acute respiratory syndrome among community physicians, nurses, and emergency medical responders.

text: INTRODUCTION The preparedness levels of front-line clinicians including physicians, nurses, emergency medical responders (EMRs), and other medical staff working in clinics, offices and ambulatory care centers must be assessed, so these personnel are able to deal with communicable and potentially lethal diseases, such as severe acute respiratory syndrome (SARS). In order to determine the knowledge of these clinicians, a survey of their understanding of SARS and their use of educational resources was administered. METHODS A questionnaire was distributed to physicians, nurses, and EMRs attending conferences on SARS in the summer of 2003. Questions related to information sources, knowledge of SARS, and plans implemented in their workplace to deal with it. Statistical analysis was performed using the Statistical Package for the Social Sciences (10.1 Program, SPSS Inc., Chicago, Illinois). RESULTS A total of 201 community healthcare providers (HCPs) participated in the study. A total of 51% of the participants correctly identified the incubation period of SARS; 48% correctly identified the symptoms of SARS; and 60% knew the recommended infection control precautions to take for families. There was little difference in knowledge among the physicians, nurses, and EMRs evaluated. Media outlets such as newspapers, journals, television, and radio were reported as the main sources of information on SARS. However, there appears to be a growing use of the Internet, which correlated best with the correct answers on symptoms of SARS. Fewer than one-third of respondents were aware of a protocol for SARS in their workplace. A total of 60% reported that N-95 masks were available in their workplace. CONCLUSION These findings suggest the need for more effective means of education and training for front-line clinicians, as well as the institution of policies and procedures in medical offices, clinics, and emergency services in the community.


title: Retrospective multicenter study of Solitaire FR for revascularization in the treatment of acute ischemic stroke.

text: BACKGROUND AND PURPOSE The purpose of this study was to evaluate safety and efficacy of the Solitaire FR device in the treatment of patients with acute ischemic stroke secondary to large artery occlusion. METHODS We conducted a retrospective study of consecutive patients presenting with acute ischemic stroke treated with Solitaire FR as the first-line device to restore blood flow in 6 experienced European centers. This study was entirely funded and supported by Coviden Neurovascular. An independent Corelab determined modified Thrombolysis in Cerebral Infarction scores on the preprocedure and postprocedure angiograms. Complete revascularization was defined as modified Thrombolysis in Cerebral Infarction 2b or 3 post-Solitaire FR device use. Symptomatic intracranial hemorrhage was defined as parenchymal hemorrhage Type 2 associated with a decline of ≥ 4 points in the National Institutes of Health Stroke Scale score within 24 hours or causing death. Favorable functional outcome was considered as modified Rankin Scale score ≤ 2 at Day 90. RESULTS We studied 141 patients (mean age, 66 years; median National Institutes of Health Stroke Scale, 18); 74 patients received intravenous tissue-type plasminogen activator before endovascular treatment. Complete revascularization was achieved in 120 of 142 occlusion sites (85%) and good outcome in 77 of 141 (55%) patients. Good outcome was more frequent in patients treated with intravenous tissue-type plasminogen activator than in those without (66% versus 42%; P<0.01). Symptomatic intracranial hemorrhage was reported in 5 patients (4%) and 29 of 141 (20%) patients died or were lost during follow-up (3 cases). CONCLUSIONS This retrospective study with centralized evaluation shows that the use of Solitaire FR is safe and achieves good revascularization rates and functional outcomes in patients with acute ischemic stroke and large artery occlusion.


docid: qnpaxlou

title: A comparison between barbed and nonbarbed absorbable suture for fascial closure in a porcine model.

text: BACKGROUND The use of knotless barbed sutures has shortened operation times for wound closure. In experimental models, their use in tendon surgery is still under investigation. This study looks at the use of barbed sutures in a porcine model for fascial repair when compared with traditional absorbable suture to further extend their clinical use. METHODS Six animals were included in this study. Each had two paramedian incisions, down to the fascia at the junction between the lateral edge of the rectus abdominis muscle and the transverse abdominis/oblique muscles of the abdominal wall. One fascial incision was closed with 2-0 Quill polydioxanone barbed suture and the other was closed with the control suture 1-0 PDS II (polydioxanone). The overlying skin was closed with Quill polydioxanone barbed suture for both incisions. At 6 weeks, the fascia was excised and the suture lines were tested for tensile strength. RESULTS There were no wound infections and no incisional hernias. The Quill polydioxanone barbed suture had a mean tissue tensile strength of 265.59 N (range, 206.86 to 306.38 N) and the control suture (polydioxanone) had a mean tissue tensile strength of 227.28 N (range, 132.79 to 290.35 N). The difference was not statistically significant (p = 0.341). CONCLUSIONS This study demonstrated that barbed sutures for fascial repair have equivalent tensile strength when compared with traditional nonbarbed sutures, with no adverse events such as wound dehiscence or incisional hernia. This preclinical study lends support to the practice of using barbed sutures for indications such as rectus sheath plication.


title: Viral pathogenesis of a nephrotropic infectious bronchitis virus isolated from commercial pullets.

text: Infectious bronchitis was diagnosed in 3-to-4-week-old pullets from an outbreak in a commercial flock in California. The disease was characterized by head swelling, watery discharge from the eyes and nostrils, and urates in kidneys. Mortality ranged from 1.8% to 12.5% per week. The isolation of a coronavirus from a suspension of pooled kidneys from clinically ill chickens at the fifth passage in 10-day-old chicken embryos, gross and histologic renal lesions, and seroconversion by enzyme-linked immunosorbent assay in inoculated birds suggested that the virus isolated was a nephrotrophic strain of infectious bronchitis virus (IBV). The virus isolate was found to be a previously unrecognized serotype, based on virus neutralization tests performed in embryonated chicken eggs. Nephropathogenicity of the IBV isolate was confirmed by inoculation of the viral isolate into specific-pathogen-free chicks and demonstration of renal lesions. The isolation of nephrotropic strains of IBV has not been reported previously from poultry in California.


title: Traumatic triceps tendon avulsion in a dog: magnetic resonance imaging and surgical management evaluation.

text: We report here the clinical presentation, magnetic resonance imaging (MRI) findings and successful surgical management associated with triceps tendon avulsion in a dog. A definitive diagnosis of triceps tendon avulsion was made based on MRI with evidence of displacement of the triceps tendon. Surgical correction of triceps tendon avulsion was performed with two horizontal mattress sutures using polyester and two tunnels drilled in the olecranon to reattach the tendon to the proximal olecranon. At 9 months, there was no evidence of lameness on the left thoracic limb. This is the first case report to describe MRI evaluation for the diagnosis of the triceps tendon avulsion.


title: Chinese herbs combined with Western medicine for severe acute respiratory syndrome (SARS).

text: BACKGROUND Severe acute respiratory syndrome (SARS) is an acute respiratory disease, which first appeared in Foshan City, China on 22 December 2002. It was reported by some that Chinese herbs played an important role in the treatment of SARS patients. OBJECTIVES To evaluate the possible effectiveness and safety of Chinese herbs combined with Western medicines versus Western medicines alone for SARS patients. SEARCH STRATEGY We searched the following electronic databases for reports of randomised controlled trials: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005); MEDLINE (1966 to September 2005); EMBASE (1990 to December 2004); and Chinese Biomedical Literature (lssue 2, 2005). SELECTION CRITERIA Randomized and quasi-randomized controlled trials of Chinese herbs combined with Western medicines versus Western medicines alone for diagnosed SARS patients were included. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data from each trial. We extracted dichotomous and continuous data with 95% confidence intervals (CI). For dichotomous data, relative risk (RR) was used. For continuous data, we calculated weighted mean differences (WMD). Overall results were calculated based on the random effects model if heterogeneity existed between studies. If no heterogeneity was detected between the studies, we used the fixed effects model. Using the Z score and the chi square statistic with significance being set at p < 0.05 tested heterogeneity. MAIN RESULTS We finally included twelve randomized controlled trials and one quasi-randomized controlled trial. A total of 654 SARS patients and 12 Chinese herbs were identified. We did not find Chinese herbs combined with Western medicines decreased morbidity versus Western medicines alone. Two herbs may improve symptoms. Five herbs may improve lung infiltrate absorption. Four herbs may decrease the dosage of corticosteroids. Three herbs may improve the quality of life of SARS patients. One herb may shorten the length of stay in hospital. Only two trials reported adverse events. AUTHORS' CONCLUSIONS Chinese herbs combined with Western medicines made no difference in decreasing morbidity versus Western medicines alone. It is possible that Chinese herbs combined with Western medicines may improve symptoms, quality of life, and lung infiltrate absorption and decrease the corticosteroid dosage for SARS patients. The evidence is weak because of the poor quality of the included trials. Long-term of follow up of these included trials is needed.


WHO issues global alert on respiratory syndrome.


title: Dispositional optimism is unidimensional or bidimensional? The Portuguese revised Life Orientation Test.

text: The aim of the study is to adapt and then discuss the appropriateness of the Life Orientation Test as a one or two dimension scale. The research includes two studies; one is composed of a sequential sample of 280 people with multiple sclerosis, 71% female, and another includes a convenience sample of 615 individuals from the community, 51.1% female. Because the construct is built upon a theoretical assumption that has one dimension, we examine the hypothesis of one or two factor solutions through confirmatory factor analysis, and the two-dimension solution premise demonstrates better adjustment for both samples. The other psychometric properties explored show appropriate results for the Portuguese sample, and similar to the original ones; the Test therefore seems appropriate for use in cross cultural studies. Based on our results, we discuss whether the questionnaire is a one or two dimension instrument, concluding that it appears appropriate to accept the recommendations of the original authors to use it as a one-dimensional tool and, when necessary, to use both dimensions.


title: Complementary and alternative medicine is expected to make greater contribution in controlling the prevalence of influenza.

text: Influenza pandemics are a serious threat to public health in today's world. In the past 10 years, the outbreak of three forms of severe influenza--H5N1, H1N1, and H7N9--has caused tremendous loss of life and property. In order to better cope with pandemics, antivirals such as oseltamivir are being stockpiled in great quantities, placing a substantial burden on government budgets and potentially resulting in massive waste because of the uncertainty as to when an influenza pandemic will strike and whether emerging virus strains will be resistant to the stockpiled drugs. Complementary and alternative medicine (CAM) is generally available, affordable, and commonly used in China and many other countries and CAM has a long track record of fighting influenza. The Chinese Government appropriated funds to intensively investigate herbal medicines in accordance with the principles of evidence-based medicine in order to identify effective, inexpensive, and easily stockpiled medicines. Thus far, several drugs including Shufeng Jiedu capsules, Lianhua Qingwen capsules, Maxing Shigan decoction, Yinqiao powder, and Jinhua Qinggan granules have demonstrated effectiveness in fighting influenza. In the future, CAM is expected to make greater contribution in controlling the prevalence of influenza pandemics.


title: Kitten mortality in the United Kingdom: a retrospective analysis of 274 histopathological examinations (1986 to 2000).

text: The postmortem findings in 274 kittens were reviewed. The kittens were grouped by age at death: perinatal (< one day), neonatal (one to 14 days), preweaning (15 to 34 days) and postweaning (35 to 112 days); 203 (74 per cent) of the kittens were postweaning and 38 (14 per cent) were preweaning. Infectious disease was identified in 55 per cent of the kittens, and 71 per cent of the infectious disease was viral and detected significantly more frequently in rescue shelter kittens than in kittens from private homes. Twenty-five per cent of all kitten mortality was due to feline parvovirus (FPV). During the neonatal and preweaning periods, the main viral infections were feline herpesvirus and calicivirus. Feline infectious peritonitis caused the death of 17 kittens in the postweaning period. The rescue shelter kittens were significantly younger than the kittens from private homes (median survival 49 and 56 days) and were more likely to have FPV. The non-pedigree kittens were significantly younger than the pedigree kittens (42 v 56 days), and the pedigree kittens were significantly less likely to originate from rescue shelters. There was no significant difference between the age distribution of the male and female kittens. No diagnosis could be found in 33 per cent of the kittens, and this failure was correlated significantly with the submission of tissue samples as opposed to the whole carcase.


title: Influenza vaccination in patients with asthma: effect on the frequency of upper respiratory tract infections and exacerbations.

text: Influenza epidemics of variable extent and severity occur every winter and are frequently associated with exacerbations of asthma. Accordingly, annual vaccination against influenza is recommended for patients with asthma. However, there are very limited data concerning its protective effect in this group of patients. The aim of this study was to assess the effect of influenza vaccination on the frequency of upper respiratory tract infections and also asthma-related outcomes such as exacerbation rates, hospital admissions, and rescue courses of oral corticosteroids in patients with stable asthma. Between September 15 and November 7, 2001, a total of 128 patients with asthma were randomly assigned to receive (n = 86) and not to receive vaccine (n = 42). The primary outcome measures were frequency of upper respiratory tract infections and exacerbations of asthma during the winter following vaccination. Study subjects were asked to record the presence and duration of symptoms suggestive of an upper respiratory tract infection and call their physician in the presence of conditions suggestive of an exacerbation until March 2002. Among the vaccinated group, 48% of the patients reported that they had no upper respiratory tract infection during the winter following injection, whereas 57% of nonvaccinated participants were upper respiratory symptom free during the same period (p > 0.05). The frequency of upper respiratory tract infection was also not different between the two groups in all severity forms of asthma (p > 0.05). There was no significant difference in the frequency of exacerbations of asthma between the two groups during the study period (p > 0.05). None of the vaccinated group was hospitalized due to an asthma attack; however, two patients (4.8%) in the nonvaccinated group had to be hospitalized following an exacerbation (p > 0.05). In summary, our findings do not support the protective effect of influenza vaccination for patients with asthma. However, no firm conclusions on this effect of the vaccine can be made without the data on the rate of influenza epidemic in that season and without the knowledge of the cause of upper respiratory tract infections in those patients. Therefore, we believe randomized, double-blind, placebo-controlled studies, including larger subgroups of severe asthmatics, are needed to evaluate the protective effect of influenza vaccination in asthma.


title: COVID-19-associated Hemophagocytic Lymphohistiocytosis and Coagulopathy: Targeting the Duumvirate.

text: CONTEXT Preliminary data on coexistence of secondary hemophagocytic lymphohistiocytosis syndrome (HLH) and disseminated intravascular coagulation (DIC) in critically ill children with novel coronavirus disease (COVID-19) are emerging. Herein, we summarize the available literature and fill-in the gaps in this regard. EVIDENCE ACQUISITION We have performed a literature search for articles in PubMed, EMBASE and Google Scholar databases till May 12, 2020, with following keywords: "COVID-19", "SARS-CoV-2", "HLH", "HScore", "coagulopathy", "D-dimer", "cytokine storm", "children" and "pediatrics" with interposition of Boolean operator "AND". RESULTS Children presenting with moderate-severe COVID-19 and Kawasaki disease shock-like syndrome exhibit peripheral blood picture analogous to HLH. HScore, a validated tool to diagnose HLH, has been suggested to screen severe COVID-19 patients for cytokine storm. However, HScore faces certain limitations in this scenario. It may be more pragmatic to use 'high D-dimer' (> 3 µg/mL) instead of 'low fibrinogen' to facilitate early detection of cytokine storm. COVID-19 associated coagulopathy resembles hypercoagulable form of DIC with bleeding being rarely reported. Although the International Society on Thrombosis and Haemostasis (ISTH) interim guidance recommends low molecular weight heparin in all hospitalized patients, data is lacking in population below 14 years of age. However, in the presence of life-threatening thromboembolic event or symptomatic acro-ischemia, unfractionated heparin (UFH) should be used with caution. CONCLUSION HScore can be used as a complement to clinical decision for initiating immunosuppression. Children with moderate-to-severe COVID-19, especially those with documented thrombocytopenia or chilblains, should be regularly monitored for coagulopathy.


title: Identification of SARS-COV spike protein-derived and HLA-A2-restricted human CTL epitopes by using a new muramyl dipeptidederivative adjuvant.

text: Severe acute respiratory syndrome (SARS) spread during the winter of 2003, and attempts have been made to develop vaccines against SARS corona virus (SARS-CoV). The present study provides a strategy to rapidly identify SARS-CoV-derived antigenic peptides recognized by HLA-A2-restricted cytotoxic T lymphocytes (CTLs). Forty-three candidate peptides having HLA-A2-binding motifs were selected in silico and HLA-A2/Db chimeric MHC class I-transgenic mice were immunized with these peptides and a new derivative of muramyl dipeptide that can induce upregulation of HLA-DR, CD80, CD86, and CD40 in human CD14+ antigen presenting cells, was administered as an adjuvant. Six HLAA2-restricted mouse CTL epitopes were identified, including two new epitopes which have never been reported before. One of the novel peptides was naturally processed and successfully induced HLAA2-restricted specific CTLs in both HLA transgenic mice and healthy donors. The method was useful, convenient and efficient for rapid identification of CTL epitopes derived from SARS-CoV proteins and will be possibly applicable for other pathogens to develop a peptide-based vaccine.


title: The evolution of ethics for community practice.

text: Defining the community as client or partner requires a different ethical approach, an approach focused on the aggregate, community, or societal level. A discussion of rule ethics, virtue ethics, and feminist ethics transports the community practitioner beyond traditional ethical principles to consider a more contemporary ethical foundation for public health and community practice. Inclusion, diversity, participation, empowerment, social justice, advocacy, and interdependence create an evolving ethical foundation to support community practice. Collaboration among health care professionals and members of the organizations, communities, and societies in which they practice will facilitate the further development of moral thought and ethical theory to underpin community practice.


title: Secondary prevention of stroke: an evidence-based clinical audit in the primary care.

text: OBJECTIVE To audit secondary preventive care in non-acute stroke patients in a local General Outpatient Clinic of the Hospital Authority. DESIGN Comparison of two samples from a case series at different time-points. SETTING General Outpatient Clinic, Hong Kong. PATIENTS Non-acute stroke patients fulfilling the inclusion criteria and regularly followed up in a local General Outpatient Clinic during the audit cycle were recruited. Evidence-based audit criteria and performance standards were established after thorough literature review. A sample from this case series was compared retrospectively at two time-points. First-phase evaluation was performed in October 2009 and deficiencies were identified. After 9 months of active intervention, second-phase evaluation was performed in July 2010. Chi squared test and student's t test were used to compare the significance of relevant changes noted. RESULTS First-phase data showed marked deficiencies in proper assessment of cardiovascular risk factors. Satisfactory blood pressure, glucose and lipid control was evident only in 47% of the hypertensive, 45% of the diabetic, and 37% of the dyslipidaemic stroke patients, respectively. After 9 months of implementing changes, significant improvements were noted with respect to standard targets being achieved. In the second phase, more comprehensive tackling of cardiovascular risk factors was noted, with satisfactory blood pressure control in 73% of hypertensive patients, and adequate metabolic control in 62% diabetic patients (P<0.01 for both). Only 59% of the dyslipidaemic stroke patients had optimal lipid control, though their mean low-density lipoprotein concentration was significantly reduced (P<0.05). CONCLUSION This study provided a valuable lesson in identifying deficiencies in secondary prevention for stroke patients managed in a local primary care facility. Using a team approach intervention, quality assurance was promoted and a definite impact on patient care was demonstrated.


title: Seroprevalence of SARS coronavirus antibody in household contacts.

text: Between March and July 2003, 671 cases of severe acute respiratory syndrome (SARS) were diagnosed in Taiwan with a total of 84 fatalities. After the epidemic, a serological survey was conducted involving the asymptomatic household contacts. Household contacts of 13 index patients were enrolled in the study. Contact history and clinical symptoms of the household contacts were recorded by standardized questionnaires. Blood samples of patients and household contacts were collected at least 28 days after symptom onset in the index patients or household exposure in the contacts for SARS-associated coronavirus (SARS-CoV) IgG testing. On the basis of this investigation, 29 persons (25 adults and 4 children) were identified as having had unprotected exposure to the index cases before infection-control practices were implemented. Laboratory evaluation of clinical specimens showed no evidence of transmission of SARS-CoV infection to any contacts. This investigation demonstrated that subclinical transmission among household contacts was low in the described setting.


How did COVID-19 pandemic changed the Portuguese rheumatology?


title: Surveillance of severe acute respiratory syndrome (SARS) in the post-outbreak period.

text: INTRODUCTION This retrospective one-month survey evaluated the practicality of post-severe acute respiratory syndrome (SARS) surveillance recommendations in previously SARS-affected countries, namely Singapore. These included staff medical sick leave for febrile illness, inpatient fevers, inpatient pneumonia, atypical pneumonia, febrile illnesses with significant travel history and sudden unexplained deaths from pneumonia/ adult respiratory distress syndrome (ARDS). METHODS Surveillance data on medical sick leave of staff, all inpatient fevers, all febrile (temperature greater than or equal to 38 degrees Celsius) inpatient pneumonia, including atypical pneumonia, and deaths from pneumonia were collected from sick leave reports, ward reports, isolation room rounds and mortuary reports from 1 to 28 September 2003. RESULTS Baseline results show 167 (1.4/1000 staff-days) observed in staff sick leave for febrile illnesses, and 1798 (71.3/1000 bed-days) observed for inpatient fever. There were 40, 31 and 12 instances, respectively, of staff having temperatures of high fever (greater than or equal to 38 degrees Celsius), prolonged sick leave (3 days or more), and repeated sick leave (within 7 days) for febrile illnesses. An average of 4.6 wards a day potentially fulfilled the World Health Organisation SARS alert criteria. Of 27 cases with fever, pneumonia and a total white count of less than 10,000 cells per cubic mm as per Ministry of Health, Singapore criteria for the diagnosis of atypical pneumonia, only five were identified by clinicians. CONCLUSION Surveillance is time-consuming and current recommendations are not specific enough to be used practically. Surveillance indicators for inpatients must overcome a high degree of background noise.


title: Limitations on human rights: are they justifiable to reduce the burden of TB in the era of MDR- and XDR-TB?

text: Tuberculosis, in all its forms, poses a serious, demonstrable threat to the health of countless individuals as well as to health as a public good. MDR-TB and, in particular, the emergence of XDR-TB, have re-opened the debate on the importance, and nature, of treatment supervision for basic TB control and the management of drug-resistant TB. Enforcing compulsory measures regarding TB patients raises questions of respect for human rights. Yet, international law provides for rights-limiting principles, which would justify enforcing compulsory measures against TB patients who refuse to have diagnostic procedures or who refuse to be monitored and treated once disease is confirmed. This article analyzes under what circumstances compulsory measures for TB patients may be enforced under international law. Compulsory measures for TB patients may, in fact, be justified on legal grounds provided that these measures are foreseen in the law, that they are used as a last resort, and that safeguards are in place to protect affected individuals. The deadly nature of the disease, its epidemiology, the high case fatality rate, and the speed at which the disease leads to death when associated with HIV are proven.