title: [Roles of multidisciplinary team in diagnosis and treatment of suspected cases of COVID-19].

text: OBJECTIVE To analyze the roles of multidisciplinary team (MDT) in the diagnosis and treatment of suspected cases of coronavirus disease 2019 (COVID-19). METHODS The clinical data of 48 patients with suspected COVID-19 admitted in Jinhua Municipal Central Hospital from January 21, 2020 to March 20, 2020 were retrospectively analyzed. RESULTS In the 48 suspected cases, 18 were diagnosed with COVID-19, and 30 were excluded. Each of the confirmed cases were discussed among MDT for 2 to 12 times with an average of (4.7±3.2) times; while for non-COVID-19 patients were discussed for 2 to 4 times with an average of (2.3±0.6) times. With the guidance of MDT, one COVID-19 patient was transferred to designated provincial hospital after effective treatment; one patient complicated with acute cholecystitis underwent gallbladder puncture and drainage; and COVID-19 was excluded in a highly suspected patient after alveolar lavage fluid examination. Except one transferred patient, all 17 confirmed COVID-19 patients were cured and discharged. There was no cross-infection occurred in suspected patients during the hospitalization. There were no deaths and no medical staff infections. CONCLUSIONS The efficiency of diagnosis and treatment for suspected COVID-19 patients can be improved with MDT, particularly for complicated cases.


Management of Burn Wounds Under Prolonged Field Care.


title: COVID 19- Clinical Profile, Radiological Presentation, Prognostic Predictors, Complications and Outcome: A Perspective from the Indian Subcontinent.

text: Background Since December 2019, we have been facing one of the worst pandemics of human history. It originated from the Hubei province in China as a case of pneumonia, later named COVID-19.1 The causative pathogen, a new enveloped betacoronavirus2 is now known as Severe acute respiratory syndrome corona virus-2 (SARS-CoV 2). India reported its first case of COVID19, on 30th January 2020. We aim to identify the defining clinical and radiological characteristics, severity and prognosis, along with impact of age on outcome. Methods Cross sectional, observational study of patients diagnosed with COVID -19 [RT-PCR]. Results We observed male predominance, mean age of 36 years, with less or no symptoms, majority brought in after screening and contact tracing by the screening teams. Thrombocytopenia, lymphocytosis, raised LDH was common (>35%, p<0.05). Patients over the age of 60 were the ones having severe illness and more complications (p<0.05). Radiographic abnormality was frequently associated irrespective of clinical presentation and its severity. Poor prognosis was noted in elderly, especially those with co-morbidities. Discussion Though the disease has a relatively mild course in this part of the subcontinent, patients aged ≥60 are at significant risk for morbidity and mortality. Clinical and laboratory findings are similar to those found in viral diseases. Increased risk of cardiac involvement needs to be looked into. Chest X-ray proves sufficient for imaging, reducing the requirement of CT scans. Studies involving larger sample size and interventional trials are need of the hour.


title: Neurobiological and psychological correlates of suicidal attempts and thoughts of death in patients with major depression.

text: Suicide is a major problem for psychiatry. Depression is the most common mental disorder related to suicidal behavior. The present study aimed at investigating the relationship between the symptomatology related to death, dying, and suicide and neurobiological factors in depressed patients. Fifty patients aged 21-60 years suffering from major depression were investigated. Schedules for Clinical Assessment in Neuropsychiatry version 2.0 and the International Personality Disorder Examination were used to assist the clinical diagnosis. The psychometric assessment included the Hamilton Depression Rating Scale, the Hamilton Anxiety Scale, the 1965 and 1971 Newcastle Depression Diagnostic Scales, the Diagnostic Melancholia Scale, the General Assessment of Functioning Scale, and the Personality Deviance Scale. Psychophysiological methods included electro-oculogram, flash electroretinogram under photopic and scotopic conditions, and pattern-reversal visual evoked potentials. Biological markers included the 1-mg dexamethasone suppression test, the 30-mg dexfenfluramine challenge test, and brain (99m)Tc-HMPAO SPECT. Statistical analysis included one-, two-, and three-way Manova and Mancova and the Scheffé test as post hoc test. Patients without thoughts of death had higher self-confidence levels and less overdependency on others and intropunitiveness. The suicidal patients had a significantly prolonged pattern-reversal visual evoked potential latency in comparison with the other patients. The findings of this were related to the status of the patient at the time of the interview but not to his/her history. They also provide neurobiological data to support the need for a combined presence of self-directed aggression and a higher arousal level or disinhibition of self-directed aggressive thoughts in order for a patient to become suicidal. Further study is needed to test whether psychophysiological methods, which are noninvasive and easy to perform, are of value in the therapeutic planning and monitoring of responses.


title: Antigenic variation among transmissible gastroenteritis virus (TGEV) and porcine respiratory coronavirus strains detected with monoclonal antibodies to the S protein of TGEV.

text: Five nonneutralizing monoclonal antibodies (MAb) generated to the virulent Miller strain of transmissible gastroenteritis virus (TGEV) and specific for the S protein were characterized. Competition assays between purified and biotinylated MAb indicated that MAb 75B10 and 8G11 mapped near a new subsite, designated V and 2 MAb, 44C11 and 45A8, mapped to a previously designated subsite D. A fifth MAb mapped between subsites V and E. These MAb were tested with 3 previously characterized MAb to subsites A, E, and F in fixed-cell ELISA and cell culture immunofluorescent assays against 5 reference and 9 field strains of TGEV and 2 US strains (ISU-1 and ISU-3) of porcine respiratory coronavirus (PRCV). Subsites A, E, and F were conserved on all TGEV and PRCV strains examined. The 2 MAb to subsite V, 8G11 and 75B10, reacted only with the Miller TGEV strains (M5C, M6, and M60), except that 75B10 also recognized field strain U328. The MAb 11H8 did not react with 4 field strains or the Purdue strains of TGEV. The 2 MAb to subsite D reacted with all TGEV strains examined, but not with 2 US PRCV strains, 2 European PRCV strains, 1 feline infectious peritonitis virus strain, and 1 canine coronavirus strain. Because of this specificity for TGEV, but not PRCV, these latter 2 subsite D MAb may be useful for the development of competition ELISA to differentiate serologically between TGEV and PRCV infections in swine, similar to the currently used European subsite D MAb.


title: Biophysical properties of coronavirus strain OC 43.

text: Coronavirus OC 43 from suckling mouse brains was subjected to sucrose density gradient centrifugation. Maxima of complement fixing (CF) activities occurred in the ribosomal (density 1.14) and mitochondrial (density 1.19) fraction which contained incomplete, damaged virus particles. The haemagglutinating (HA) activity was associated with the microsomal soluble protein fraction displayed no antigenic activity. The isolated purified virus proved to be very unstable.


title: Detection of rotavirus and coronavirus shedding in two beef cow herds in Idaho.

text: Fecal samples were taken at the time of pregnancy examinations and at parturition from two beef herds. They were also taken from sick calves at the onset of disease, and from 25% of the healthy calves at 15 days of age. All fecal samples were examined by electron microscopy for viruses.Four cows in herd A were detected excreting coronavirus, one at the time of the pregnancy examinations and three at parturition. The first cow was removed from the herd and the others calved at the end of the season. There were no sick calves.No cows in herd B were detected excreting virus at the time of pregnancy checks, but fourteen coronavirus and two rotavirus carrier cows were found at parturition. All but two calves sampled had large numbers of virus particles in their feces. Clinical illness was associated with dams shedding virus and with nightly low temperatures.


title: Pilot survey of the diagnosis and management of heart failure in primary care: a Singaporean perspective.

text: INTRODUCTION The diagnosis and management of congestive heart failure at the primary care level is difficult. Despite advances in medical therapy, namely angiotensin-converting enzyme inhibitors and beta-blockers, congestive heart failure remains a common cause of hospital visits. The extent to which these advances have been implemented in primary care is uncertain. We therefore sought to assess current practice patterns of primary care physicians and identify obstacles to optimal diagnosis and management of congestive heart failure in Singapore. MATERIALS AND METHODS Telephone interviews of 100 primary care physicians using structured questionnaires. RESULTS Primary care physicians diagnose congestive heart failure based on the presence of breathlessness (92.5%), lung crackles (52.5%), peripheral oedema (55.0%) and findings on chest radiography (76.8%). Only 1 in 3 mentioned raised jugular venous pressure as a useful diagnostic sign. Echocardiography was not commonly obtained (5%), mainly due to inaccessibility. While many (47.5%) were aware of the importance of angiotensin-converting enzyme inhibitors, few (16.2%) knew of the impact of beta-blockers on morbidity and mortality. Instead, diuretics were thought to be most important for prolonging survival in congestive heart failure (47.5%). The main obstacle to widespread angiotensin-converting enzyme inhibitors usage was dry cough. Patient compliance (57.5%) and cost (82.5%) were the main obstacles to optimising care. CONCLUSIONS Local primary care physicians diagnose congestive heart failure using non-specific symptoms and signs. Obstacles to optimal congestive heart failure management were identified. We hope our results will lead to strategies to improve patient care.


title: Rhinoviruses and coronaviruses - virological aspects of their role in causing colds in man.

text: Rhinoviruses are picornaviruses that cause colds. They are naturally temperature sensitive and highly adapted to grow in respiratory epithelium. Coronaviruses are structurally quite different, being enveloped viruses but are also adapted to grow in respiratory epithelium and also cause colds.


Transvenous Salvage of Migrated Large Volume Detachable Coil.


title: Dodging the CTL response: viral evasion of Fas and granzyme induced apoptosis.

text: The importance of CTL induced apoptosis as a vital part of the protection of host organisms from pathogenic viruses cannot be overstated. Conversely, the ability of a virus to evade CTL induced apoptosis is equally important to its survival. Important insights in viral pathogenesis and host immunology have been discovered through observations of this constantly evolving interchange. This mini review will build upon previously published comprehensive reviews by reorganizing the anti-apoptotic strategies specific for CTL induced apoptosis and integrating recent discoveries in viral evasion of Fas/FasL and perforin/granzyme mediated apoptosis. This updated look at viral evasion in the context of the CTL response should generate dialogue and provide impetus for research to illuminate interactions between the best defense against viruses and the viral adaptations to evade this defense.


Experimental infection with a virulent pneumoenteric isolate of bovine coronavirus.


title: Risk factors for feline infectious peritonitis among cats in multiple-cat environments with endemic feline enteric coronavirus.

text: OBJECTIVE To determine what risk factors, other than genetic predisposition, contribute to the incidence of feline infectious peritonitis (FIP) in private breeding catteries and animal shelters. DESIGN Cats from 7 catteries and a shelter were observed monthly for 1 year. At each visit, cats were examined, fecal samples were collected for determination of feline coronavirus shedding, and blood samples were collected for determination of coronavirus antibody titers. Diagnostic tests were performed on all cats that died of FIP. ANIMALS 275 purebred or random-bred cats that were kept by private breeder-owners in homes. RESULTS 24 cats died of FIP during the study. Development of FIP was not associated with cattery, mean cat number, mean age, sex, cattery median coronavirus antibody titer, husbandry and quarantine practices, caging and breeding practices, or prevalence of concurrent diseases. However, risk factors for FIP included individual cat age individual cat coronavirus titer, overall frequency of fecal coronarvirus shedding, and the proportion of cats in the cattery that were chronic coronavirus shedders. Deaths from FIP were more frequent in fall and winter, and on the basis of analysis of cattery records, the number of deaths varied yearly. Epidemics (> 10% mortality rate) were reported at least once in 5 years in 4 catteries. CLINICAL IMPLICATIONS Elimination of FIP from a cattery is only possible by total elimination of endemic feline enteric coronavirus (FECV) infection. The most important procedure to reduce FECV from catteries is elimination of chronic FECV shedders.


title: Detection of the ORF3 polypeptide of feline calicivirus in infected cells and evidence for its expression from a single, functionally bicistronic, subgenomic mRNA.

text: Feline calicivirus (FCV) is a small positive-stranded RNA virus within the family Caliciviridae. Its genome is 7690 nucleotides in length and encodes three open reading frames (ORFs). The smallest, ORF3, is located at the extreme 3' end of the genome and can potentially encode a polypeptide of approximately 12 kDa. In this paper, we report the identification of an ORF3-encoded polypeptide in FCV-infected cells using an antiserum raised against a bacterially-expressed bacteriophage T7 gene 10-ORF3 fusion protein. Although a small mRNA of 0-5 kb, which could potentially encode ORF3, has been described, reports on the number and size of FCV subgenomic RNAs have varied considerably. To clarify the situation, RNAs from FCV-infected cells were labelled in vivo using [32P]orthophosphate, an approach which provided definitive data. Only two RNA species were detected, the genomic RNA and a subgenomic mRNA of 2.4 kb. The 5' end of the subgenomic mRNA was mapped to position 5227 on the genomic RNA using RNA sequencing and primer extension methods. RNA isolated from FCV-infected cells in which no subgenomic RNA smaller than 2.4 kb was detectable directed the synthesis in rabbit reticulocyte lysate of the ORF3-encoded polypeptide. Furthermore, a synthetic RNA copy of the 2-4 kb subgenomic mRNA of FCV, containing both ORF2 and ORF3 polypeptides in the in vitro translation system. These data strongly suggest that ORF3 is expressed from the 2-4 kb subgenomic RNA and that this RNA is functionally bicistronic. The possible mechanisms by which ORF3 is expressed are discussed.


title: The nucleoprotein is required for efficient coronavirus genome replication.

text: The construction of a set of transmissible gastroenteritis coronavirus (TGEV)-derived replicons as bacterial artificial chromosomes is reported. These replicons were generated by sequential deletion of nonessential genes for virus replication, using a modified TGEV full-length cDNA clone containing unique restriction sites between each pair of consecutive genes. Efficient activity of TGEV replicons was associated with the presence of the nucleoprotein provided either in cis or in trans. TGEV replicons were functional in several cell lines, including the human cell line 293T, in which no or very low cytopathic effect was observed, and expressed high amounts of heterologous protein.


title: Development of an enzyme-linked immunosorbent assay to detect chicken parvovirus-specific antibodies.

text: Here we report the development and application of an enzyme-linked immunosorbent assay (ELISA) to detect parvovirus-specific antibodies in chicken sera. We used an approach previously described for other parvoviruses to clone and express viral structural proteins in insect cells from recombinant baculovirus vectors. In baculovirus recombinant-infected Sf9 cells, the chicken parvovirus (ChPV) structural viral protein 2 (VP2) was detected as an abundant protein, and the 60-kDa VP2 strongly reacted with parvovirus-infected chicken serum in Western blot. A semipurified VP2 was then used in capture ELISA. Sera from chickens experimentally infected with ChPV and sera from uninfected chickens were tested to evaluate the assay. The ELISA was 93.3% sensitive and 100% specific in detecting ChPV-infected birds. Subsequent assays identified IgG type ChPV-specific maternally acquired antibodies in day-old chickens and demonstrated the production of virus-specific antibodies in young birds following infection with ChPV. In our study, a specific antibody response of infected chickens was observed starting with IgM production between 14 and 21 days postinfection (DPI) and switching into a predominant IgG response by 32 DPI. The availability of an ELISA for detection of virus-specific antibodies and its ability to differentiate between maternally acquired antibodies and antibodies produced following acute infection could prove to be a valuable tool to characterize pathobiological properties and immunogenicity of ChPV.


title: Detection of antibody to turkey coronavirus by antibody-capture enzyme-linked immunosorbent assay utilizing infectious bronchitis virus antigen.

text: An antibody-capture enzyme-linked immunosorbent assay (ELISA) for detection of antibody to turkey coronavirus (TCV) utilizing infectious bronchitis virus (IBV) antigen was developed. Anti-TCV hyperimmune turkey serum and normal turkey serum were used as positive or negative control serum for optimization of the ELISA system. Goat anti-turkey immunoglobulin G (light plus heavy chains) conjugated with horseradish peroxidase was used as detector antibody. The performance of the ELISA system was evaluated with 45 normal turkey sera and 325 turkey sera from the field and the cutoff point was determined. Serum samples of turkeys experimentally infected with TCV collected sequentially from 1 to 63 days postinfection were applied to the established antibody-capture ELISA using IBV antigens. The optimum conditions for differentiation between anti-TCV hyperimmune serum and normal turkey serum were serum dilution at 1:40 and conjugate dilution at 1:1600. Of the 325 sera from the field, 175 were positive for TCV by immunofluorescent antibody (IFA) assay. The sensitivity and specificity of the ELISA relative to IFA test were 93.1% and 96.7%, respectively, based on the results of serum samples from the field turkey flocks using the optimum cutoff point of 0.18 as determined by the logistic regression method. The ELISA values of all 45 normal turkey sera were completely separated from that of IFA-positive sera. The ELISA results of serum samples collected from turkeys experimentally infected with TCV were comparable to that of the IFA assay. Reactivity of anti-rotavirus, anti-reovirus, anti-adenovirus, or anti-enterovirus antibodies with the IBV antigens coated in the commercially available ELISA plates coated with IBV antigens could be utilized for detection of antibodies to TCV in antibody-capture ELISA.


title: Quality assurance for the diagnostics of viral diseases to enhance the emergency preparedness in Europe.

text: The threat posed by emerging and re-emerging communicable diseases and, more recently, by the intentional release of infectious agents in a susceptible population, has been receiving considerable attention at the national and international levels. Public health efforts to strengthen disease detection, surveillance and control have been intensified. However, clinicians and clinical microbiology laboratories play an important role in the early detection of disease, the identification of the putative agent, and notification of the appropriate authorities. To be effective in this role, laboratories must be specially prepared to handle viral agents safely, and need, among other things, the appropriate rapid and sensitive diagnostic tests. In 1998 the European Network for Diagnostics of 'Imported' Viral Diseases (ENIVD) was established. ENIVD presently comprises, as permanent members, 44 expert laboratories in 21 European Union (EU) member states and 4 non-EU countries and is one of the networks on infectious diseases funded by the European Commission. ENIVD fulfils many of the important tasks required for the surveillance and control of imported, rare and emerging viral infections such as the exchange of expertise and the organisation of external quality assurance (EQA) programmes, both of which are needed to improve diagnostics. Here, we summarise the data generated by recent EQA activities focussed on the diagnostics of infections with hantavirus, dengue virus, filovirus, Lassa virus, orthopox virus and the SARS-coronavirus (SARS-CoV). These were carried out between 1999 and 2004 and involved 93 laboratories from 41 countries, including laboratories from additional countries outside of Europe. Particularly the EU-candidate countries and Eastern neighbouring countries will be invited to join the network in the near future. A public website is available at http://www.enivd.de.


docid: nuhldzwx

title: MHC class II-restricted T-cell hybridomas recognizing the nucleocapsid protein of avian coronavirus IBV.

text: Mice were immunized with purified infectious bronchitis virus (IBV), strain M41. Spleen cells, expanded in vitro by stimulation with M41, were immortalized by fusion to obtain T-cell hybridomas, and two major histocompatability complex (MHC) class II (I-E)-restricted T-cell hybridomas were selected with specificity for IBV. Both hybridomas selectively recognized the internal nucleocapsid protein. The responses to 12 different strains of IBV varied markedly. This demonstrates antigenic variation of the nucleocapsid protein in addition to the known variation of the surface glycoprotein S.


title: Enteric viruses detected by molecular methods in commercial chicken and turkey flocks in the United States between 2005 and 2006.

text: Intestinal samples collected from 43 commercial broiler and 33 commercial turkey flocks from all regions of the United States during 2005 and 2006 were examined for the presence of astrovirus, rotavirus, reovirus, and coronavirus by reverse transcription-polymerase chain reaction (PCR), and for the presence of groups 1 and 2 adenovirus by PCR. Phylogenetic analysis was performed to further characterize the viruses and to evaluate species association and geographic patterns. Astroviruses were identified in samples from 86% of the chicken flocks and from 100% of the turkey flocks. Both chicken astrovirus and avian nephritis virus (ANV) were identified in chicken samples, and often both viruses were detected in the same flock. Turkey astrovirus type-2 and turkey astrovirus type-1 were found in 100% and 15.4% of the turkey flocks, respectively. In addition, 12.5% of turkey flocks were positive for ANV. Rotaviruses were present in 46.5% of the chicken flocks tested and in 69.7% of the turkey flocks tested. Based upon the rotavirus NSP4 gene sequence, the chicken and turkey origin rotaviruses assorted in a species-specific manner. The turkey origin rotaviruses also assorted based upon geographical location. Reoviruses were identified in 62.8% and 45.5% of chicken and turkey flocks, respectively. Based on the reovirus S4 gene segment, the chicken and turkey origin viruses assorted separately, and they were distinct from all previously reported avian reoviruses. Coronaviruses were detected in the intestinal contents of chickens, but not turkeys. Adenoviruses were not detected in any chicken or turkeys flocks. Of the 76 total chicken and turkey flocks tested, only three chicken flocks were negative for all viruses targeted by this study. Most flocks were positive for two or more of the viruses, and overall no clear pattern of virus geographic distribution was evident. This study provides updated enteric virus prevalence data for the United States using molecular methods, and it reinforces that enteric viruses are widespread in poultry throughout the United States, although the clinical importance of most of these viruses remains unclear.


title: Poverty and the economic effects of TB in rural China.

text: OBJECTIVE To investigate the economic effects of illness on individual tuberculosis (TB) cases in rural China and to use a case-control study to show a strong TB-poverty link. SETTING In 2002-2004 we studied 160 new smear-positive pulmonary tuberculosis (PTB) cases and 320 age- and sex-matched controls living in neighbouring houses in four rural counties of Henan Province. DESIGN Cases and controls were interviewed 1-3 months after patients were diagnosed. We used matched multivariate logistic regression to compare cases with controls for poverty status using household income, household assets and relative wealth within the village. We conducted follow-up interviews of patients 10-12 months later to assess economic effects by collecting data on treatment costs, income losses, coping strategies and treatment completion. RESULTS Poverty is strongly associated with TB incidence even after controlling for smoking and other risk factors. Excluding income losses, direct out-of-pocket treatment costs (medical and non-medical) accounted for 55.5% of average annual household income, and most TB cases fell into heavy debt. The DOTS cure rate was 91%. When DOTS was incomplete or not done, mortality was high. CONCLUSIONS Poverty is both a cause and a devastating outcome of TB. Ongoing poverty reduction schemes in China must also include reducing TB.


title: "Hook and roll technique" using an articulating hook cautery to provide a critical view during single-incision laparoscopic cholecystectomy.

text: We describe a new simple and easy technique called the "Hook and roll technique" (HRT) that uses an articulating hook cautery to provide a critical view during single incision laparoscopic cholecystectomy (SILC). A 2-cm incision is made at the umbilicus to insert three 5-mm trocars or a multichannel port. After dissection of the serosa of the dorsal and ventral sides of the gall bladder, including Calot's triangle, the angled tip of the hook cautery is inserted between the cystic artery and duct with its tip placed dorsally. The tip is then rotated in a clockwise manner to avoid bile duct injury, allowing the connective tissue between them to be hooked, coagulated and cut. This procedure is repeated several times, followed by dissection between the cystic artery and the liver bed to achieve a critical view. From December 2008 to May 2011, 121 patients underwent SILC using HRT in our hospital without any serious complications. This technique is suitable for SILC, as it is consists of simple procedures that can be performed safely and easily, even by left hand in a cross-over approach, and it allows complete dissection of Calot's triangle to achieve a critical view without using any dissector under dangerous in-line viewing.


docid: owiovmfj

title: Interaction of lyssaviruses with the low-affinity nerve-growth factor receptor p75NTR.

text: The low-affinity nerve-growth factor receptor p75NTR interacts in vitro with the rabies virus (RV) glycoprotein and serves as a receptor for RV. The Lyssavirus genus comprises seven genotypes (GTs) of rabies and rabies-related viruses. The ability of p75NTR to interact with the glycoprotein of representative lyssaviruses from each GT was investigated. This investigation was based on a specific binding assay between BSR cells infected with a lyssavirus and Spodoptera frugiperda (Sf21) cells expressing p75NTR on the cell surface. A specific interaction was observed with the glycoprotein of GT 1 RV (challenge virus standard or Pasteur virus strains) as well as wild-type RV and the glycoprotein of GT 6 European bat lyssavirus type 2. In contrast, no interaction was detected with the glycoprotein of lyssaviruses of GTs 2-5 and 7. Therefore, p75NTR is only a receptor for some lyssavirus glycoproteins, indicating that the other GTs must use an alternative specific receptor.


title: Continuing evolution of opioid use in primary care practice: implications of emerging technologies.

text: BACKGROUND Primary care physicians, nurse practitioners, and nurses are often the first to evaluate patients with pain and many patients depend on these clinicians for pain relief. The growing evidence supporting use of opioids for appropriately selected patients means that primary care practitioners must be knowledgeable regarding ever-evolving pain-management strategies. SCOPE This review summarizes core considerations in opioid prescribing in the primary care setting, the risks of undertreatment of pain, the challenges and barriers associated with prescribing opioids, identifying risk factors that may predict problematic use, and emerging formulation technologies expected to assist clinicians in better achieving effective pain control while minimizing risks for misuse or diversion. RESULTS Primary care physicians face considerable challenges in optimizing pain management while minimizing potential for misuse, abuse and diversion. Opioid treatment decisions are based not only on the type of pain but also the patient's psychosocial history, including a screening for predicting aberrant behaviors and, in some patients, substance abuse. New opioid formulations are available to assist clinicians in achieving adequate patient relief while reducing risk of tampering and abuse. Primary care practitioners need to be aware of these new options and integrate them into clinical treatment decisions. CONCLUSIONS The strategic use of new opioid formulations and better patient assessment may lead to more successful use of opioids in the management of pain, while limiting or lowering the risk of the development of an addiction problem, abuse or diversion.


title: Prior infection of nursery-age pigs with porcine reproductive and respiratory syndrome virus does not affect the outcome of transmissible gastroenteritis virus challenge.

text: Thirty-six specific-pathogen-free pigs were weaned at 2 weeks of age and separated into 4 treatment groups (A-D, 9 pigs/group). Treatment groups B and D were infected with porcine reproductive and respiratory syndrome virus (PRRSV), whereas groups A and C remained uninfected. Two weeks later, 1 pig from each group was necropsied to assess gross lung involvement, and then the remaining group D PRRSV-infected pigs and the group C uninfected pigs were challenged at 4 weeks of age with transmissible gastroenteritis virus (TGEV) to determine if prior infection with PRRSV increased the severity of TGEV disease after challenge. One hundred percent morbidity but no mortality occurred in pigs following challenge. Clinically, pigs of both groups C and D were similar in terms of onset and severity of diarrhea. The serum antibody response to TGEV and the amount and duration of TGEV shedding after challenge was similar for both groups. Only a few pigs in each group had a transient fever postchallenge, and both group C and group D pigs began to recover and to gain weight at or near the end of the first week postchallenge. It was concluded that the clinical course of TGEV disease was not markedly affected by infection of pigs with TGEV 2 weeks after they had been infected with PRRSV.


title: Sequencing needs for viral diagnostics.

text: We built a system to guide decisions regarding the amount of genomic sequencing required to develop diagnostic DNA signatures, which are short sequences that are sufficient to uniquely identify a viral species. We used our existing DNA diagnostic signature prediction pipeline, which selects regions of a target species genome that are conserved among strains of the target (for reliability, to prevent false negatives) and unique relative to other species (for specificity, to avoid false positives). We performed simulations, based on existing sequence data, to assess the number of genome sequences of a target species and of close phylogenetic relatives (near neighbors) that are required to predict diagnostic signature regions that are conserved among strains of the target species and unique relative to other bacterial and viral species. For DNA viruses such as variola (smallpox), three target genomes provide sufficient guidance for selecting species-wide signatures. Three near-neighbor genomes are critical for species specificity. In contrast, most RNA viruses require four target genomes and no near-neighbor genomes, since lack of conservation among strains is more limiting than uniqueness. Severe acute respiratory syndrome and Ebola Zaire are exceptional, as additional target genomes currently do not improve predictions, but near-neighbor sequences are urgently needed. Our results also indicate that double-stranded DNA viruses are more conserved among strains than are RNA viruses, since in most cases there was at least one conserved signature candidate for the DNA viruses and zero conserved signature candidates for the RNA viruses.


Aerosol-generating procedures and risk of transmission of acute respiratory infections: a systematic review.


docid: sltazgbr

title: Antigenic and polypeptide structure of bovine enteric coronavirus as defined by monoclonal antibodies.


Chicken flu races through Dutch poultry farms.


title: Structure of the antiviral assembly inhibitor CAP-1 complex with the HIV-1 CA protein.

text: The CA domain of the human immunodeficiency virus type 1 (HIV-1) Gag polyprotein plays critical roles in both the early and late phases of viral replication and is therefore an attractive antiviral target. Compounds with antiviral activity were recently identified that bind to the N-terminal domain of CA (CA N) and inhibit capsid assembly during viral maturation. We have determined the structure of the complex between CA N and the antiviral assembly inhibitor N-(3-chloro-4-methylphenyl)-N'-{2-[({5-[(dimethylamino)-methyl]-2-furyl}-methyl)-sulfanyl]ethyl}-urea) (CAP-1) using a combination of NMR spectroscopy and X-ray crystallography. The protein undergoes a remarkable conformational change upon CAP-1 binding, in which Phe32 is displaced from its buried position in the protein core to open a deep hydrophobic cavity that serves as the ligand binding site. The aromatic ring of CAP-1 inserts into the cavity, with the urea NH groups forming hydrogen bonds with the backbone oxygen of Val59 and the dimethylamonium group interacting with the side-chains of Glu28 and Glu29. Elements that could be exploited to improve binding affinity are apparent in the structure. The displacement of Phe32 by CAP-1 appears to be facilitated by a strained main-chain conformation, which suggests a potential role for a Phe32 conformational switch during normal capsid assembly.


title: [Preparation of specific monoclonal antibody against nucleocapsid protein of SARS coronavirus].

text: AIM To express nucleocapsid(N) protein of SARS coronavirus and produce monoclonal antibody(mAb) to N protein. METHODS N protein gene was amplified by RT-PCR. After being confirmed by DNA sequencing, the gene was subcloned into prokaryotic expression vector. N protein expressed in E.coli was recovered from SDS-PAGE gel and served as immunogen in the preparation of the mAb. RESULTS DNA sequencing confirmed that the amplified fragment was N protein gene. SDS-PAGE analysis showed that the M(r) of the expressed protein was approximately 43 kd. This expressed protein could be further confirmed in Western blot by using serum from a convalescent SARS patient as primary antibody. Western blot analysis proved that three mAbs obtained could react specifically to the recombinant N protein. CONCLUSION The prepared recombinant N protein and mAbs against N protein lay the foundation for further development of early diagnosis assays for SARS coronavirus infection.


title: A new era in HIV vaccine development.

text: Since the identification of HIV in 1984, the search for a safe and effective vaccine has been relentless. While investigator-initiated research has provided substantial information regarding HIV disease and pathogenesis, and over two dozen drugs are licensed in the USA to treat HIV, the global epidemic continues unabated. Early in HIV vaccine research, the pharmaceutical industry took the initiative to produce products for clinical testing. As the likelihood of a quick success decreased, private investment waned. The public sector responded with novel mechanisms to engage industry while continuing to support academic investigators. HIV vaccine research continues to rely on the creativity of individual investigators, as well as collaborations that vary in size and complexity and offer opportunities for the efficient use of resources and accelerated progress.


title: Systematic Review and Meta-analysis of Prophylactic Mesh During Primary Stoma Formation to Prevent Parastomal Hernia.

text: BACKGROUND Implantation of mesh at the time of stoma formation may reduce the rate of parastomal hernia. Until recently, the evidence has been limited to only a few small randomized controlled trials. OBJECTIVE We present an updated systematic review and meta-analysis to assess the effect of mesh prophylaxis on rates of parastomal hernia. We examine ongoing and unpublished trials via online registries and propose recommendations for future research. DATA SOURCES MEDLINE, EMBASE, and the Cochrane Library were searched up to March 2016 for published randomized controlled trials. Sixteen international trial registries were inspected for ongoing and unpublished trials. STUDY SELECTION Randomized controlled trials comparing mesh versus no mesh on the incidence of parastomal hernia after colostomy or ileostomy formation were selected. MAIN OUTCOME MEASURES The primary outcome measure was rate of parastomal hernia at least 12 months after stoma formation. Secondary outcomes included rates of stoma-related complications. RESULTS Of 3005 studies identified, 7 randomized controlled trials (432 patients) were eligible for inclusion in the final analysis. All were at high risk of bias. Mesh reduced the incidence of clinically detected parastomal hernia (10.8% vs 32.4%; p = 0.001) (risk ratio, 0.34; 95% CI, 0.18-0.65; I = 39%) and the rate of radiologically detected parastomal hernia (34.6% vs 55.3%; p = 0.01) (risk ratio, 0.61; 95% CI, 0.42-0.89; I = 44%). No increase in the incidence of stoma-related complications was observed with the use of prophylactic mesh. Results from ongoing and unpublished randomized controlled trials are expected, but few will report on alternative mesh types or surgical techniques. LIMITATIONS Heterogeneity of interventions, small patient populations, and a high risk of bias seen in all studies implicate cautious interpretation of the results. CONCLUSION Mesh prophylaxis at the time of stoma formation appears safe and effective in preventing parastomal hernia; however, limitations of the primary evidence justify larger, more rigorous randomized controlled trials.


title: Diseases, parasites and survival of coyotes in south-central Georgia.

text: Serologic testing, radio-telemetry and post-mortem diagnostic evaluations were used to investigate survival and causes of mortality among 17 coyotes (Canis latrans) in south-central Georgia (USA). Prevalence of canine heartworm (Dirofilaria immitis) microfilariae was lower (P = 0.057) among fall-captured (22%) than among winter-captured (75%) coyotes. Prevalence of heartworm was higher among adults than juveniles in the fall, but no significant difference was detected between animals captured in winter. Antibodies were found against canine parvovirus (65%), canine parainfluenza virus (59%), infectious canine hepatitis virus (41%), and Toxoplasma gondii (18%). Antibodies were not found to Brucella canis, canine coronavirus, five serovars of Leptospira interrogans, or canine distemper virus. Seroprevalence of canine parvovirus was lower (P = 0.009) among fall-captured animals (33%) than winter-captured animals (100%). The Kaplan-Meier estimate of annual survival was 0.500 for all animals. Juvenile survival did not differ (P = 0.79) from adult survival, but male survival (S = 0.217) was lower (P = 0.11) than female survival (S = 0.804). Two of nine (22%) mortalities were human-caused, one was due to concurrent canine parvovirus and canine distemper virus infections, one animal died of trauma, two were considered natural mortalities of unknown cause, and no cause of death could be determined for the remaining three animals. Natural mortality may be significant for coyotes in south-central Georgia, although there was no apparent link between exposure to pathogens and the animals' subsequent fate in our small sample.


title: High prevalence of respiratory viral infections in patients hospitalized in an intensive care unit for acute respiratory infections as detected by nucleic acid-based assays.

text: Forty-seven bronchoalveolar lavages (BAL) were obtained from 41 patients with acute pneumonia attending an intensive care unit. By molecular diagnosis, 30% of total BAL and 63% of bacteria-negative BAL were positive for respiratory viruses. Molecular detection allows for high-rate detection of respiratory viral infections in adult patients suffering from severe pneumonia.


title: Burnout in nursing staff: is there a relationship between depression and burnout?

text: OBJECTIVE There is evidence that burnout may be a clinical entity with pathological stress reaction features related to the inability in finding pleasure from work. The purpose of this study was to investigate the relationship between burnout and depression. METHODS The study took place in the general hospital AHEPA of Thessaloniki. All members of the nursing staff (in total 368 subjects) took part. The protocol was self-reported and anonymous, in order to obtain as valid data as possible and included the Maslach Burnout Inventory (MBI) to assess the level of burnout, the Eysenck Personality Questionnaire (EPQ) to assess personality traits, and the Zung Self-Rating Depression Scale to assess depressive symptomatology. RESULTS The analysis revealed a weak but significant relationship between burnout and depression. CONCLUSIONS Depression is a pervasive disorder that affects almost every aspect of the patient's life. On the contrary, burnout is, by definition, a syndrome restricted to the patient's professional environment. However, it seems that there may be two distinct types of burnout syndromes, of which the one comprising the majority of nurses has little or no common features with depression. The second type consists of individuals with a predisposition to develop burnout. The latter is characterized by more severe symptomatology, phenotypic similarity to depression and presumably common etiological mechanisms.


title: Clinico-Radiological Evaluation and Correlation of CT Chest Images with Progress of Disease in COVID-19 Patients.

text: Purpose The present study was undertaken to investigate and quantify the severity of COVID-19 infection on high-resolution chest computed tomography (CT) and to determine its relationship with clinical parameters. This study also aimed to see CT changes with clinical recovery or progression of disease. Materials and methods In an attempt to provide extensive information pertaining to clinical and radiological characteristics of COVID-19, the present study was undertaken in 80 hospitalized patients. The patients were COVID-19 confirmed positive by genomic analysis through RT-PCR at tertiary care center in Jaipur. Initially all patients were evaluated for their clinical parameters and then correlated with HRCT chest after hospitalization. CT findings correlated with duration of disease to assess progress or recovery. Results A total of 80 patients of laboratory confirmed COVID-19 test by RT-PCR at SMS Hospitals, Jaipur were assessed. Among the confirmed cases, most of patients were young adults in the fifth and sixth decade of age group with mean age of 50.40 years. There was a male preponderance (59% male and 41% female). Out of total analyzed patients, 39 patients (48.75%) were symptomatic, among them fever (79.47%), cough (74.35%), shortness of breath (36%) and sore throat (17.94%) were the most common presenting clinical manifestations. A few patients (12.82%) also had other symptoms like headache, chest pain, pain abdomen, altered sensorium etc. 54% patients had some underlying co morbid disease in sample population. The most prevalent comorbidities were Diabetes mellitus (56%), Hypertension (48.83%), COPD/K-chest (12%), CAD (9.32%) and others (11.62%) like hypothyroidism, anemia, CVA etc. The lung pathological changes were evaluated by HRCT imaging and by assigning CT severity score. We found Typical COVID findings in 50% patients, Indeterminate in 11%, Atypical in 11% and 28% patients had Negative CT chest for COVID. The clinical status of patients correlated with the CT severity score, with mild cases showing score <15/25 in 45.83% patients and severe cases showing CT severity score >15/25 in 87.50% patients. The CT features varied with duration and course of disease. Proportional GGO was higher (59.37%) in early phase and it was lower (12.5%) in later stage of disease. Conclusion The varied spectra of COVID-19 presentation included fever, cough, shortness of breath, sore throat etc. Diabetes mellitus, hypertension, COPD/K-Chest and CAD were found as major comorbid conditions. Symptomatic presentation of COVID-19 was observed to be higher in patients with co morbid disease, especially if multiple. HRCT chest in COVID-19 patients had a major diagnostic and prognostic importance as positive CT findings were more prominent in symptomatic patients and co-morbid patients. Clinical symptoms of patients directly correlated with CT severity index. CT imaging was found to be useful in predicting clinical recovery of patients or progression of disease.


title: Aged BALB/c mice as a model for increased severity of severe acute respiratory syndrome in elderly humans.

text: Advanced age has repeatedly been identified as an independent correlate of adverse outcome and a predictor of mortality in cases of severe acute respiratory syndrome (SARS). SARS-associated mortality may exceed 50% for persons aged 60 years or older. Heightened susceptibility of the elderly to severe SARS and the ability of SARS coronavirus to replicate in mice led us to examine whether aged mice might be susceptible to disease. We report here that viral replication in aged mice was associated with clinical illness and pneumonia, demonstrating an age-related susceptibility to SARS disease in animals that parallels the human experience.


title: Evaluation of a commercial real-time PCR kit for detection of dengue virus in samples collected during an outbreak in Goiania, Central Brazil, in 2005.

text: In the past 2 decades, dengue has reemerged in Brazil as a significant public health problem. Clinicians demand a diagnostic test with high sensitivity that is applicable during the early symptomatic phase. We aimed to test two distinct molecular methods on samples from suspected dengue cases during an outbreak in Central Brazil. Acute-phase serum specimens from 254 patients suspected of having dengue were collected during 2005 in the city of Goiânia, Central Brazil. Samples were blindly evaluated by real-time and multiplex PCR in addition to routine immunoglobulin M serology and virus culture. Overall, acute dengue was confirmed by serology, multiplex PCR, or virus isolation for 80% of patients (203/254). Another four patients presented real-time PCR-positive results as the unique marker of dengue. Higher real-time PCR positivity levels and viral loads were observed in the early symptomatic phase of disease (< or =5 days) than after this period. Multiplex and real-time PCR assays presented a high kappa agreement (0.85). According to multiplex PCR, 60 samples harbored dengue virus type 3 (DEN-3), 4 samples harbored DEN-2, and 1 sample displayed a pattern compatible with a double infection with DEN-2 and -3. The dengue virus real-time kit was found to be practical and adjustable for high throughput, to display the best performance in the early symptomatic phase of dengue cases, and to be valuable for confirming dengue diagnosis in a timely manner.


title: [A new polyvalent vaccine against enteral infections in newborn calves].

text: The most frequent microbial causative agents of massive diarrheas in new-born calves kept on large cattle farms in the CSSR are rotaviruses, coronaviruses and enterotoxigenic strains of E. coli, manifesting themselves as complicated virus-bacterial infections. An inactivated polyvalent adjuvant vaccine has been developed for the prevention and specific prophylaxis of these enteral infections; the vaccine contains bovine rotavirus, bovine coronavirus and three enterotoxigenic serotypes of E. coli with protective antigen K 99. The rotavirus and coronavirus are propagated on the stable cellular line MDBK and inactivated with 0.2% formalin, the Escherichia strains are submersed in the MINCA culture medium during their cultivation and inactivated with 0.5% formalin. The vaccine was prepared as a blend of the same amounts of rotavirus and coronavirus and of such an amount of bacterin so that 1 ml of the vaccine will contain 10(9) bacteria. One part of oil adjuvant was added to five parts of the virus-bacterial blend and the blend was homogenized in the Ultraturax apparatus. The vaccine is to be used for immunization of pregnant cows and heifers; in these animals it induces the production of specific antibodies to all antigens contained in the vaccine. Its immunogenic effects were checked in 32 calves and 38 cows in the herds with the occurrence of diarrheas caused by both enteropathogenic viruses and enterotoxigenic escherichia. It was demonstrated that the inactivation did not influence in either of the viruses the process of inducing the production of specific antibodies, and the antibody response of the calves and heifers after application of 2 ml of complete inactivated vaccine was equally strong as after application of live vaccine containing only rotavirus and coronavirus. The level of the rotavirus antibodies increased on the average 30 times and 200 times, coronavirus antibodies twice and four times. The antibody response to coronavirus was negatively influenced by the relatively high levels of antibodies before vaccination. The antibody response to antigen K 99 was expressive in all cases.


docid: grtjvnkl

title: Web-based geographic information system tools and international surveillance network for bluetongue in the Balkans and south-east Europe (East-BTNet).

text: Bluetongue (BT) is an infectious, non-contagious vector-borne disease. Since 1998, the disease has spread across the Mediterranean Basin and into the Balkans. During a Workshop devoted to the electronic identification of animals and bluetongue, held in Civitella del Tronto, Teramo, in December 2002, the representatives of Balkan and Eastern Mediterranean countries stated the need for implementing a regional surveillance network capable of collecting and disseminating relevant epidemiological data on BT. Consequently, the 'Cooperation for implementing a surveillance network for bluetongue in the Balkan area' (East-BTNet) project was implemented by the World Organisation for Animal Health Collaborating Centre for veterinary training, epidemiology, food safety and animal welfare (Istituto Zooprofilattico dell'Abruzzo e del Molise 'G. Caporale'). The information network established within the East-BTNet project is based on internet links and on geographic information system website technologies. This facilitates the rapid collection, analysis, interpretation and dissemination of large quantities of data generated by the national monitoring programmes of countries participating in the project (Albania, Bosnia-Herzegovina, Bulgaria, Croatia, Cyprus, the Former Yugoslav Republic of Macedonia, Malta, Romania, Serbia and Montenegro, Slovenia and Turkey).


title: Complementarity in the supramolecular design of arenaviruses and retroviruses revealed by electron cryomicroscopy and image analysis.

text: Arenaviruses are rodent-borne agents of diseases, including potentially lethal human hemorrhagic fevers. These enveloped viruses encapsidate a bisegmented ambisense single-stranded RNA genome that can be packaged in variable copy number. Electron cryomicroscopy and image analysis of New World Pichinde and Tacaribe arenaviruses and Old World lymphocytic choriomeningitis virus revealed pleomorphic enveloped particles ranging in diameter from approximately 400 to approximately 2,000 A. The surface spikes were spaced approximately 100 A apart and extended approximately 90 A from the maximum phospholipid headgroup density of the outer bilayer leaflet. Distinctive stalk and head regions extended radially approximately 30 and approximately 60 A from the outer bilayer leaflet, respectively. Two interior layers of density apposed to the inner leaflet of the viral lipid bilayer were assigned as protein Z and nucleoprotein (NP) molecules on the basis of their appearance, spacing, and projected volume. Analysis of en face views of virions lacking the GP-C spikes showed reflections consistent with paracrystalline packing of the NP molecules in a lattice with edges of approximately 57 and approximately 74 A. The structural proteins of retroviruses and arenaviruses assemble with similar radial density distributions, using common cellular components.


title: Viral loads in clinical specimens and SARS manifestations.

text: 1. A high viral load in nasopharyngeal aspirate (with or without a high viral load in serum) is a useful prognostic indicator of respiratory failure or mortality. The presence of viral RNA in multiple body sites is also indicative of poor prognosis. 2. Early treatment with an effective antiviral agent before day 10 may decrease the peak viral load, and thus ameliorate the clinical symptoms and mortality, and reduce viral shedding and the risk of transmission


title: Balancing infection control practices and family-centred care in a cohort of paediatric suspected severe acute respiratory syndrome patients in Hong Kong.

text: OBJECTIVE To identify key nursing issues for paediatric patients suspected of severe acute respiratory syndrome (SARS) in relation to the family-centred model of nursing care and to develop a data-based model of paediatric nursing care to be better applied in situations of suspected SARS or where outbreaks of other infectious diseases occur. METHODS This is a retrospective descriptive case series, which analysed the medical and nursing records of all highly-suspected/suspected SARS patients admitted to a major acute hospital in Hong Kong. Key nursing personnel were also interviewed. RESULTS The study included a total of 17 highly-suspected and 49 suspected SARS paediatric patients (age: 1-16). None of the paediatric patients was eventually diagnosed of SARS. Most cases presented fever (highly-suspected: 76.5%/ suspected: 100%), cough (64.7%/71.4%), nausea and vomiting (35.3%/28.6%). Nursing care was provided to the patients as necessary. Both the children and parents experienced fear of SARS, as well as separation anxiety arisen from hospitalization in a strict isolation setting. CONCLUSIONS Infection control overshadowed the family-centred nursing practices in the management of SARS paediatric patients. A major nursing care issue for SARS paediatric patients was to achieve a careful balance between attending to patients' physical and psychological needs and adhering to the infection control guidelines, while at the same time offering psychological support to family members. The current philosophy and practice of family-centred nursing model neglect the special needs of children with infectious diseases and predominantly apply to children with non-infectious diseases that family visits are allowed and nursing care by parents are encouraged.


Disease watch.


title: Single trocar transanal endoscopy in a child.

text: Single trocar transanal endoscopic surgery (STTE) is a well-known technique for evaluation and management of rectal lesions in adults. We used an 11mm balloon trocar with a 10mm operative optic, introduced into the anal canal to excise a rectal lesion along with multiple rectal biopsies in a child. Rectal visibility was good with an ease to maintain the rectum insufflated.


Murine coronavirus temperature sensitive mutants.


title: Grasping the initiative in health policy research and reform.

text: The conference highlighted the need for new policy development using quantitative methods.


title: Impact of ibuprofen administration on renal drug clearance in the first weeks of life.

text: The administration of ibuprofen or any other nonselective cyclooxygenase (COX) inhibitor drug in early neonatal life is associated with a reduction of glomerular filtration, which reduces the elimination of drugs dependent on renal function for clearance. However, the relationship between COX inhibitor drug indication (prophylactic or therapeutic) and the magnitude of this effect remains unclear. Observations collected in two population pharmacokinetic studies, in preterm neonates, investigating amikacin and vancomycin were used to estimate: i) the impact of ibuprofen administration on the clearance of these drugs; and ii) the difference between prophylactic and therapeutic administration of ibuprofen on this clearance. Prophylactic administration of ibuprofen to preterm neonates on the first day of life to enhance closure of an asymptomatic patent ductus arteriosus (PDA) reduced amikacin clearance by 21% while coadministration of ibuprofen to induce closure of a symptomatic PDA resulted in an 18% reduction in vancomycin clearance in the first month of postnatal life. A significant and clinically relevant reduction in drug clearance is observed when ibuprofen is coadministered independent of indication, postmenstrual or postnatal age. Population modeling with covariate analyses can provide us with the tools to further disentangle the impact of nonselective COX-inhibitors on renal drug clearance.


title: Surveillance of influenza virus B circulation in Northern Italy: summer-fall 2008 isolation of three strains and phylogenetic analysis.

text: Influenza virus type B strains were unexpectedly detected and isolated in Italy during summer-fall 2008 from three patients travelling to Italy from Lebanon, Senegal and Uzbekistan. The three summer-fall strains matched to a high degree the hemagglutinin (HA1) of influenza virus type B strains circulating in Italy in the second part (January through April) of the 2007/2008 season, and HA1 of the type B strains included in the 2008/2009 vaccine (B/Yamagata/16/88 lineage). Surveillance of influenza virus circulation in Western countries also during the summer-fall season may help to trace and anticipate the appearance of new influenza virus variants.


title: North American and European porcine reproductive and respiratory syndrome viruses differ in non-structural protein coding regions.

text: Although North American and European serotypes of porcine reproductive and respiratory syndrome virus (PRRSV) are recognized, only the genome of the European Lelystad strain (LV) has been sequenced completely. Here, the genome of the pathogenic North American PRRSV isolate 16244B has been sequenced and compared with LV. The genomic organization of 16244B was the same as LV but with only 63.4% nucleotide identity. The 189 nucleotide 5' non-coding region (NCR) of 16244B was distinct from the LV NCR, with good conservation (83%) only over a 43 base region immediately upstream of open reading frame (ORF) 1a. Major differences were found in the region encoding the non-structural part of the ORF1a polyprotein, which shared only 47% amino acid identity over 2503 residues of the six non-structural proteins (Nsps) encoded. Nsp2, thought to have a species-specific function, showed the greatest divergence, sharing only 32% amino acid identity with LV and containing 120 additional amino acids in the central region. Nsps encoded by the 5'-proximal and central regions of ORF1b had from 66 to 75% amino acid identity; however, the carboxy-terminal protein CP4 was distinct (42% identity). The ORF 1a-1b frameshift region of 16244B had 98% nucleotide identity with LV. Consistent with previous reports for North American isolates, the six structural proteins encoded were 58 to 79% identical to LV proteins. The 3' NCR (150 nucleotides) was 76% identical between isolates. These genomic differences confirm the presence of distinct North American and European PRRSV genotypes.


Detection of coronavirus infection of man by immunofluorescence.


title: Importance of respiratory viruses in acute otitis media.

text: Acute otitis media is usually considered a simple bacterial infection that is treated with antibiotics. However, ample evidence derived from studies ranging from animal experiments to extensive clinical trials supports a crucial role for respiratory viruses in the etiology and pathogenesis of acute otitis media. Viral infection of the upper respiratory mucosa initiates the whole cascade of events that finally leads to the development of acute otitis media as a complication. The pathogenesis of acute otitis media involves a complex interplay between viruses, bacteria, and the host's inflammatory response. In a substantial number of children, viruses can be found in the middle-ear fluid either alone or together with bacteria, and recent studies indicate that at least some viruses actively invade the middle ear. Viruses appear to enhance the inflammatory process in the middle ear, and they may significantly impair the resolution of otitis media. Prevention of the predisposing viral infection by vaccination against the major viruses would probably be the most effective way to prevent acute otitis media. Alternatively, early treatment of the viral infection with specific antiviral agents would also be effective in reducing the occurrence of acute otitis media.


title: Comparison of nucleic and amino acid sequences and phylogenetic analysis of open reading frames 3 and 4 of various equine arteritis virus isolates.

text: The genetic variation in equine arteritis virus (EAV) protein-encoding open reading frames (ORFs) 3 and 4 genes was investigated. Nucleic and deduced amino acid sequences from seven different EAV isolates (one European, one American and five Canadian isolates) and the Arvac vaccine strain were compared with those of Bucyrus reference strain. ORF 3 nucleotide and amino acid sequence identities between these isolates (including the Arvac vaccine strain) and the Bucyrus reference strain ranged from 85.6 to 98.8%, and 85.3 to 98.2%, respectively, whereas ORF 4 nucleotide and amino acid sequence identities ranged from 90.4 to 98.3%, and 90.8 to 97.4%, respectively. Phylogenetic analysis and estimation of genetic distances based on the ORF 3 nucleic acid sequences showed that the European Vienna isolate could be classified into a genetically divergent group from all other isolates and the Arvac vaccine strain. In contrast, the nucleic acid sequences of ORF 4 were found to be less variable, with a closer phylogenetic relationship evident among the EAV isolates and the Arvac vaccine strain.


title: [Epidemiological characteristics of Middle East Respiratory Syndrome outbreak in the Republic of Korea, 2015].

text: OBJECTIVE To analyze the epidemiological characteristics of Middle East Respiratory Syndrome (MERS) outbreak in the Republic of Korea in 2015 and provide related information for the public health professionals in China. METHODS The incidence data of MERS were collected from the websites of the Korean government, WHO and authoritative media in Korea for this epidemiological analysis. RESULTS Between May 20 and July 13, 2015, a total of 186 confirmed MERS cases (1 index case, 29 secondary cases, 125 third generation cases, 25 fourth generation cases and 6 cases without clear generation data), including 36 deaths (case fatality rate: 19%), were reported in Korea. All cases were associated with nosocomial transmission except the index case and two possible family infections. Sixteen hospitals in 11 districts in 5 provinces/municipalities in Korea reported confirmed MERS cases, involving 39 medical professionals or staff. For the confirmed cases and death cases, the median ages were 55 years and 70 years respectively, and the cases and deaths in males accounted for 60% and 67% respectively. Up to 78% of the deaths were with underlying medical conditions. Besides the index case, other 12 patients were reported to cause secondary cases, in which 1 caused 84 infections. One imported MERS case from Korea was confirmed in China on May 29, no secondary cases occurred. The viruses strains isolated from the cases in Korea and the imported case in China show no significant variation compared with the strains isolated in the Middle East. CONCLUSION The epidemiological pattern of the MERS outbreak in Korea was similar to MERS outbreaks occurred in the Middle East.


title: A new method for assessing the impact of emerging infections on global trade.

text: In this paper, the authors describe a new method for assessing the impact of emerging infections on global trade flows. When one compares notifications to the World Trade Organization (WTO) of the emergency measures taken to control certain animal and plant diseases with the trade values of certain products from the United Nation's Commodity Trade Statistics Database (Comtrade) (identified through the World Customs Organization's harmonised system of tariff product codes [HS]), it is possible to estimate the extent to which trade has been diverted from the affected economies. The authors study in detail the example of bovine spongiform encephalopathy (BSE). When member countries of the WTO change their import policies towards the goods of a trading partner, as the result of an emerging disease such as BSE, they must file notifications of such changes through the Sanitary and Phytosanitary Committee of the WTO. To quantify the impact of BSE on trade, the authors compared these notifications against Comtrade statistics, using the HS 1996 tariff code variable. (The HS 1996 tariff codes allow the tracking and recording of the volumes of exports and imports, in quantity and value, between any two member countries between 1998 and 2000 in the database.) The authors then used this linked dataset to describe the dollar impact of the BSE-related notifications filed in 2000 on the trade flow of imports. The results of this study suggest that economies affected by BSE notifications saw a decline of US$5.6 billion from hypothetical projections in designated products. At the same time, unaffected economies saw an increase of US$1.5 billion from hypothetical projections in the same products. Thus, it may be concluded that import restrictions to control the spread of emergent spongiform encephalopathy infection had a significant effect on trade flows. These results also emphasise the interconnectedness of global trade: trade restrictions for some economies may enhance trade opportunities for others. Further studies using these methods are warranted.


docid: xfwfdabv

title: Medical students' perceptions of an undergraduate research elective.

text: Recent years have seen a steady decline in the number of new physician-investigators (Association of American Medical Colleges, 2000). To encourage medical students to select research careers, the Queen's University Faculty of Health Sciences curriculum includes a mandatory Critical Enquiry elective in the 2nd year. An anonymous written survey was administered to medical students before and after the elective to determine their perceptions of the value of the elective and its impact on their decision to pursue a career in medical research. There was a significant increase in the number of students expressing an interest in pursuing a research career following the elective (35-42%, p = 0.029). Students recognized other benefits including the development of critical appraisal, information literacy, and critical thinking skills; and the opportunity to select an area of and form contacts for postgraduate training. Even students who choose not to pursue careers in medical research perceive benefits to a mandatory undergraduate research elective.


title: Computer modelling of an impedance-controlled pulsing protocol for RF tumour ablation with a cooled electrode.

text: PURPOSE To develop computer models to mimic the impedance-controlled pulsing protocol implemented in radiofrequency (RF) generators used for clinical practice of radiofrequency ablation (RFA), and to assess the appropriateness of the models by comparing the computer results with those obtained in previous experimental studies. METHODS A 12-min RFA was modelled using a cooled electrode (17G, 3 cm tip) inserted in hepatic tissue. The short (transverse) diameter of the coagulation zone was assessed under in vivo (with blood perfusion (BP) and considering clamping) and ex vivo (at 21 °C) conditions. The computer results obtained by programming voltage pulses were compared with current pulses. RESULTS The differences between voltage and current pulses were noticeable: using current instead of voltage allows larger coagulation zones to be created, due to the higher energy applied by current pulses. If voltage pulses are employed the model can accurately predict the number of roll-offs, although the waveform of the applied power is clearly not realistic. If current voltages are employed, the applied power waveform matches well with those reported experimentally, but there are significantly fewer roll-offs. Our computer results were overall into the ranges of experimental ones. CONCLUSIONS The proposed models reproduce reasonably well the electrical-thermal performance and coagulation zone size obtained during an impedance-controlled pulsing protocol.


title: Update: Severe acute respiratory syndrome--United States, 2003.

text: CDC continues to work with the World Health Organization (WHO) and other partners to investigate cases of severe acute respiratory syndrome (SARS). This report updates information on reported SARS cases worldwide and among U.S. residents and summarizes information on one additional case with laboratory evidence of infection with the SARS-associated coronavirus (SARS-CoV).


title: Infections with human coronaviruses NL63 and OC43 among hospitalised and outpatient individuals in São Paulo, Brazil.

text: The incidence and clinical features of human coronaviruses (HCoVs) among Brazilian patients with respiratory illness are not well known. We investigated the prevalence of HCoVs among Brazilian outpatients and hospitalised patients with respiratory illnesses during 2009 and 2010. To identify the HCoVs, pancoronavirus and species-specific reverse-transcriptase polymerase chain reaction assays were performed. Five of 394 samples were positive for HCoVs (1.2%): 1/182 (0.5%) outpatients and 4/212 (1.8%) hospitalised patients. The OC43 and NL63 HCoVs were identified. Two patients were admitted to the intensive care unit. Underlying chronic disease was reported in cases and one diabetic adult died. HCoVs can cause lower respiratory infections and hospitalisation. Patients with pre-existing conditions and respiratory infections should be evaluated for HCoV infections.


title: Identification of a novel coronavirus in patients with severe acute respiratory syndrome.

text: BACKGROUND The severe acute respiratory syndrome (SARS) has recently been identified as a new clinical entity. SARS is thought to be caused by an unknown infectious agent. METHODS Clinical specimens from patients with SARS were searched for unknown viruses with the use of cell cultures and molecular techniques. RESULTS A novel coronavirus was identified in patients with SARS. The virus was isolated in cell culture, and a sequence 300 nucleotides in length was obtained by a polymerase-chain-reaction (PCR)-based random-amplification procedure. Genetic characterization indicated that the virus is only distantly related to known coronaviruses (identical in 50 to 60 percent of the nucleotide sequence). On the basis of the obtained sequence, conventional and real-time PCR assays for specific and sensitive detection of the novel virus were established. Virus was detected in a variety of clinical specimens from patients with SARS but not in controls. High concentrations of viral RNA of up to 100 million molecules per milliliter were found in sputum. Viral RNA was also detected at extremely low concentrations in plasma during the acute phase and in feces during the late convalescent phase. Infected patients showed seroconversion on the Vero cells in which the virus was isolated. CONCLUSIONS The novel coronavirus might have a role in causing SARS.


New strategies for increasing the detection of HIV: analysis of routine data.


title: Neonatal mortality in puppies due to bacteremia by Streptococcus dysgalactiae subsp. dysgalactiae.

text: We report a case of bacteremia in puppies caused by Streptococcus dysgalactiae subsp. dysgalactiae. Identification was achieved by phenotypic and molecular genetic methods. This is the first report of the recovery of S. dysgalactiae subsp. dysgalactiae from dogs.


title: Amino terminus of the SARS coronavirus protein 3a elicits strong, potentially protective humoral responses in infected patients.

text: The 3a protein of severe acute respiratory syndrome (SARS)-associated coronavirus is expressed and transported to the plasma membrane in tissue cells of infected patients. Its short N-terminal ectodomain was found to elicit strong humoral responses in half of the patients who had recovered from SARS. The ectodomain-specific antibodies from the convalescent-phase plasma readily recognized and induced destruction of 3a-expressing cells in the presence of the human complement system, demonstrating their potential ability to provide immune protection by recognizing and eliminating SARS coronavirus-infected cells that express the target protein. In addition, when coupled to a carrier protein, the ectodomain peptide elicited 3a-specific antibodies in mice and rabbit at high titres. These results showed that the N terminus of the 3a protein is highly immunogenic and elicits potentially protective humoral responses in infected patients. Therefore, the short extracellular domain may be a valuable immunogen in the development of a vaccine for infectious SARS.


A lawyer with the Hygeia touch.


Role of macrophages and interferon in natural resistance to mouse hepatitis virus infection.


What is your diagnosis?


title: Characterization of a torovirus main proteinase.

text: Viruses of the order Nidovirales encode huge replicase polyproteins. These are processed primarily by the chymotrypsin-like main proteinases (M(pro)s). So far, M(pro)s have been studied only for corona-, arteri-, and roniviruses. Here, we report the characterization of the M(pro) of toroviruses, the fourth main Nidovirus branch. Comparative sequence analysis of polyprotein 1a of equine torovirus (EToV) strain Berne, identified a serine proteinase domain, flanked by hydrophobic regions. Heterologous expression of this domain resulted in autoprocessing at flanking cleavage sites. N-terminal sequence analysis of cleavage products tentatively identified FxxQ downward arrow(S, A) as the substrate consensus sequence. EToV M(pro) combines several traits of its closest relatives. It has a predicted three-domain structure, with two catalytic beta-barrel domains and an additional C-terminal domain of unknown function. With respect to substrate specificity, the EToV M(pro) resembles its coronavirus homologue in its preference for P1-Gln, but its substrate-binding subsite, S1, more closely resembles that of arteri- and ronivirus M(pro)s, which prefer P1-Glu. Surprisingly, in contrast to the M(pro)s of corona- and roniviruses, but like that of arterivirus, the torovirus M(pro) uses serine instead of cysteine as its principal nucleophile. Under the premise that the M(pro)s of corona- and toroviruses are more closely related to each other than to those of arteri- and roniviruses, the transition from serine- to cysteine-based proteolytic catalysis (or vice versa) must have happened more than once in the course of nidovirus evolution. In this respect, it is of interest that a mutant EToV M(pro) with a Ser165-->Cys substitution retained partial enzymatic activity.


title: [The risk and prevention of bio-aerosol transmission in dental clinics].

text: Corona virus disease 2019 (COVID-19) has become a Public Health Emergency of International Concern since its outbreak, and whether COVID-19 can transmit by aerosol remains controversial. The problem of bio-aerosol transmission in the relatively confined dental clinics has aroused wide attention in the field of dentistry. This review provided a most updated summary on the relation between bio-aerosols and dental clinics, which included the microorganisms in bio-aerosols, the bio-aerosol transmission and the sources testing methods, temporal and spatial distribution of dental bio-aerosols and summarized how to reduce the exposure to bio-aerosols in dental clinics.


Viruses of birds, mice, and men.


title: Understanding the development and perception of global health for more effective student education.

text: The concept of "global health" that led to the establishment of the World Health Organization in the 1940s is still promoting a global health movement 70 years later. Today's global health acts first as a guiding principle for our effort to improve people's health across the globe. Furthermore, global health has become a branch of science, "global health science," supporting institutionalized education. Lastly, as a discipline, global health should focus on medical and health issues that: 1) are determined primarily by factors with a cross-cultural, cross-national, cross-regional, or global scope; 2) are local but have global significance if not appropriately managed; and 3) can only be efficiently managed through international or global efforts. Therefore, effective global health education must train students 1) to understand global health status; 2) to investigate both global and local health issues with a global perspective; and 3) to devise interventions to deal with these issues.


title: Severe acute respiratory syndrome (SARS) coronavirus.

text: The global severe acute respiratory syndrome (SARS) outbreak was the first pandemic of the 21st century. Although the outbreak was successfully controlled, evidence that SARS emerged from an animal reservoir has raised concerns that another pandemic could occur. This review discusses the likelihood of another SARS pandemic and reviews the epidemiological and clinical features of the disease with an emphasis on the clinical presentation, diagnosis, and management of SARS.


title: The structure and main functions of aminopeptidase N.

text: Aminopeptidase N (APN)/CD13 is a type II metalloprotease that belongs to the M1 family of the MA clan, which consists of 967 amino acids with a short N-terminal cytoplasmic domain, a single transmembrane part, and a large cellular ectodomain containing the active site. APN has a molecular weight of 110,000. The APN exists in two forms, namely the membrane aminopeptidase N and the soluble aminopeptidase N. Moreover, it exhibits the presence of various isozymes with different functions. APN is a ubiquitous enzyme present in a wide variety of human organs, tissues and cell types (endothelial, epithelial, fibroblast, leukocyte). It is a multifunctional enzyme, related with tumorigenesis, immune system, pain etc. Furthermore, it also serves as a receptor for coronaviruses and other human viruses. Besides the manifestation of various other functions, APN is also involved in the trimming of antigen and the process of antigen presentation. These functions facilitate the modulation of bioactive peptide responses (pain management, vasopressin release) and influence immune functions and major biological events (cell proliferation, secretion, invasion, angiogenesis) thereby providing treatment options for many kinds of diseases. This review will introduce the structure and main functions of APN briefly.


title: [Prevalence and clinical characteristics of coronavirus NL63 infection in children hospitalized for acute lower respiratory tract infections in Changsha].

text: OBJECTIVE The main objective of this study was to explore the prevalence and clinical characteristics of human coronavirus NL63 infection in hospitalized children with acute lower respiratory tract infection (ALRTI) in Changsha. METHODS Nasopharyngeal aspirates (NPA) samples were collected from 1185 hospitalized children with ALRTI at the People's Hospital of Hunan province, between September 2008 and October 2010. Reverse transcriptase polymerase chain reaction (RT-PCR) was employed to screen for coronavirus NL63, which is a 255 bp fragment of a part of N gene. All positive amplification products were confirmed by sequencing and compared with those in GenBank. RESULTS The overall frequency of coronavirus NL63 infection was 0.8%, 6 (60%) out of the coronavirus NL63 positive patients were detected in summer, 2 in autumn, 1 in spring and winter, respectively. The patients were from 2 months to two and a half years old. The clinical diagnosis was bronchopneumonia (60%), bronchiolitis (30%), and acute laryngotracheal bronchitis (10%). Four of the 10 cases had critical illness, 4 cases had underlying diseases, and 7 cases had mixed infection with other viruses. The homogeneity of coronavirus NL63 with those published in the GenBank at nucleotide levels was 97%-100%. CONCLUSION Coronavirus NL63 infection exists in hospitalized children with acute lower respiratory tract infection in Changsha. Coronavirus NL63 infections are common in children under 3 years of age. There is significant difference in the infection rate between the boys and the girls: the boys had higher rate than the girls. The peak of prevalence of the coronavirus NL63 was in summer. A single genetic lineage of coronavirus NL63 was revealed in human subjects in Changsha. Coronavirus NL63 may also be one of the lower respiratory pathogen in China.


docid: dajzzzdk

title: Efficacy of a transmissible gastroenteritis coronavirus with an altered ORF-3 gene.

text: Serial passage of virulent transmissible gastroenteritis virus through cell culture reduced its virulence in 3-day-old piglets. Intramuscular inoculation of pregnant gilts with 2 doses of this modified-live virus elicited a level of lactogenic immunity that protected their nursing piglets against a lethal dose of challenge virus. Sequence analysis of a 637-bp fragment of the spike gene containing most of the aminopeptidase receptor and the 4 major antigenic sites from the original and the serially passed viruses were nearly identical. Gel analysis revealed that the fragment from the ORF-3 gene of virulent virus was smaller than the corresponding fragment from the serially passed virus. Sequence analysis of the fragment from the passed virus revealed that the sequence between nt 5310 and nt 5434 was replaced by a 636-bp fragment from the polymerase 1A gene. This replacement resulted in the loss of the CTAAACTT leader RNA-binding site and ATG start codon for the ORF-3A gene but it did not affect the ORF-3B gene.


title: An evaluation of nursing practice models in the context of the severe acute respiratory syndrome epidemic in Hong Kong: a preliminary study.

text: AIM AND OBJECTIVE Like other health-care workers, Hong Kong nurses had their professional knowledge and skills seriously challenged during the SARS outbreak. Could current nursing practices support the care of SARS or SARS-like patients in the future? If not, alternative practices would be needed. Providing a preliminary understanding, this paper compares the conventional with different nursing delivery models in a simulated SARS ward and focuses on nurses' efficiency, infection control practices and views of the two models. DESIGN AND METHODS This study was conducted in three phases. First, a baseline understanding of nursing practices was achieved through four workflow observations. In an eight-hour day, four research assistants observed nursing activities in the medical and fever wards. These data were used in the second phase to construct two sets of clinical vignettes, pertaining to SARS patient care in both conventional and alternative practice models. These scripts were discussed with nine nurses of various ranks from the hospital under study for their expert validation and input. In the third phase, nurse participants and patient actors enacted the vignettes in a simulated setting. Video-taped observations and four nurse participant interviews were employed. Observational data were analysed through descriptive statistics and independent t-tests. Textual data were coded and categorized for common meanings. RESULTS Conventional practice from the findings consisted of cubicle and named nurse nursing. While the former reflected modified team and functional nursing, it did not confine patient care within a cubicle as suggested by its name. The latter depicted a modified primary nursing approach in a team, with delegation of care. Preliminary findings concerning infection control and nurse satisfaction revealed that the alternative model had an advantage over the conventional. RELEVANCE TO CLINICAL PRACTICE This study findings lay the foundation for clinical trials, which would evaluate the significance of patient-care quality, cost-effectiveness and better human resource management by restructuring current nursing practices.


title: Development of a method for concentrating and purifying SARS coronavirus RNA by a magnetic bead capture system.

text: Severe acute respiratory syndrome (SARS) is a recently emerged infectious disease caused by a novel coronavirus, which has been designated the SARS coronavirus (SARS-CoV). To date, molecular assays for the detection of SARS-CoV has focused mainly on reverse transcriptase-PCR (RT-PCR) analysis of specimens. However, RT-PCR assays currently available have low sensitivity during the early stage of the disease in which the viral load in specimens is very low. A method for concentrating and purifying SARS-CoV RNA by a magnetic bead capture system was developed and followed by an RT-PCR assay in this study with the goal of improving the sensitivity of the RT-PCR method. This approach takes advantage of the cooperative interaction between adjacently hybridized oligonucleotides. A capture probe was covalently coupled to magnetic beads and a second probe, which anneals adjacent to the capture probe site, was prehybridized in solution to the target. It was shown that, when applied to SARS RNA samples, the sensitivity of nucleic acid capture RTPCR was about 10-fold greater than routine RT-PCR. This nucleic acid capture system was effective in improving the sensitivity of the RT-PCR, due to enriching and purifying SARS-CoV RNA. The method will be helpful for the early detection of the SARS-associated coronavirus.


title: Analysis of canine parvovirus sequences from wolves and dogs isolated in Italy.

text: The VP2 genes of Italian canine parvovirus (CPV) type 2 strains isolated from dogs and wolves were sequenced and a three-dimensional model of the VP2 capsid protein was constructed. Two mutations were detected in the VP2 sequences of the Italian strains: one at residue 297 and one at residue 265. Variant 297 is the predominant CPV isolate in Europe, whereas variant 265 has never been detected before. The mutation at residue 265 causes a disruption in a G strand of the beta-barrel in the VP2 protein. Data on strains isolated from wolves demonstrated that the same strain of CPV can circulate among domestic and wild canids; therefore, this result leads us to exclude the possibility that a separate parvovirus pool exists in wild populations.


title: Sampling considerations for detecting genetic diversity of influenza viruses in the DoD Global Respiratory Pathogen Surveillance Program.

text: The Department of Defense (DoD) Global Respiratory Pathogen Surveillance Program annually monitors the genetic diversity of influenza viruses circulating in DoD beneficiary populations. This program relies on a global network of partners across the DoD to submit respiratory specimens throughout the influenza season. In previous seasons, representative specimens for sequencing were chosen because of cost and time restrictions associated with reliance on Sanger-based sequencing technology. The effect of this specimen prioritization for sequencing has not been previously examined in the respiratory surveillance program. Here, specimen prioritization was simulated by iteratively subsetting sequencing data sets from 1 October 2013 through 15 March 2017 to determine how prioritizing affects common metrics of genetic diversity. Prioritization of specimens did not meaningfully affect calculations of average influenza genetic diversity within seasons or subtypes. Because of the high genetic diversity of influenza, prioritizing resulted in fewer unique viruses and less accurate measures of geographic relationships although it still provided relevant estimates. Given the advent of cost-effective next-generation sequencing approaches, all programs should carefully consider how best to prioritize influenza sequencing to recover meaningful information on the evolutionary dynamics of the virus.


title: Are the World Health Organisation case definitions for severe acute respiratory distress syndrome sufficient at initial assessment?

text: INTRODUCTION On March 13, 2003, Singapore doctors were alerted about an outbreak of atypical pneumonia that became known as severe acute respiratory syndrome (SARS). We now describe a series of patients that did not fit World Health Organisation (WHO) case definitions for SARS at initial assessment. METHODS The Ministry of Health, Singapore centralised SARS cases in the study hospital and its emergency department (ED) became the national screening centre. A screening questionnaire and a set of admission criteria based on WHO case definitions were applied. Patients discharged from ED were tracked via telephone surveillance and recalled if necessary. A retrospective review was done of patients who did not fit WHO definitions initially, were discharged and had re-attended. RESULTS During the outbreak, 11,461 people were screened for SARS. Among 10,075 (87.9 percent) discharged from the ED, there were 28 re-attendees diagnosed to have SARS later, giving an undertriage rate of 0.3 percent. Among the 28, six (21.4 percent) did not complain of fever and 22 (78.6 percent) had temperatures less than 38.0 degrees Celsius during their first ED visit. One patient was screened to have all three criteria but during consultation, the contact history was found to be unrelated to the known "hot spots". The initial mean temperature was 37.6 degrees Celsius (standard deviation [SD] 0.8), which increased significantly (p-value equals 0.04) to 38.0 degrees Celsius (SD 0.8) during their subsequent visit. Chest radiographs with infective changes increased significantly (p-value equals 0.009) from 16 percent to 52.4 percent over the two ED visits. CONCLUSION The WHO case definitions were helpful in evaluating majority of SARS patients initially. However under-triage at ED is inevitable, with a 0.3 percent under-triage in our study population. In this group and asymptomatic individuals who came for screening, a tracking and recall system helped to ensure their timely return to the ED.


title: Severe acute respiratory syndrome (SARS) and healthcare workers.

text: The recent outbreak of severe acute respiratory synt drome (SARS) was spread by international air travel, a direct result of globalization. The disease is caused by a novel coronavirus, transmitted from human to human by droplets or by direct contact. Healthcare workers (HCWs) were at high risk and accounted for a fifth of all cases globally. Risk factors for infection in HCWs included lack of awareness and preparedness when the disease first struck, poor institutional infection control measures, lack of training in infection control procedures, poor compliance with the use of personal protection equipment (PPE), exposure to high-risk procedures such as intubation and nebulization, and exposure to unsuspected SARS patients. Measures to prevent nosocomial infection included establishing isolation wards for triage, SARS patients, and step-down; training and monitoring hospital staff in infection-control procedures; active and passive screening of HCWs; enforcement of droplet and contact precautions; and compliance with the use of PPE.


title: Age differences in coping and emotional responses toward SARS: a longitudinal study of Hong Kong Chinese.

text: This study examined age-related emotional responses and coping at the peak and the end of the SARS outbreak in Hong Kong. Three hundred and eighty-five Hong Kong Chinese, aged 18-86 years, rated the extent that they experienced 'shock', 'sadness', 'anger' and 'fear' in the face of SARS. They also completed selected items from Brief COPE (Carver, 1997). The results showed that older adults consistently experienced less anger than did their younger counterparts. Younger adults used more emotion-focused coping than did middle-aged and older adults at the peak of SARS; yet they exhibited the lowest increase in this form of coping throughout the outbreak, such that the age differences had reversed by the end of the outbreak. Findings of this study suggest that older adults may be better at emotional regulation than are their younger counterparts, they react to a crisis with less anger and are better able to adapt their coping strategies to the changing environment.


Coronaviruses that are always present.


title: Prevalence of infections with enzootic respiratory and enteric viruses in feeder pigs entering fattening herds.

text: The prevalence of infections with H1N1- and H3N2-influenza viruses, porcine respiratory coronavirus (PRCV), transmissible gastroenteritis virus (TGEV) and porcine epidemic diarrhoea virus (PEDV) in feeder pigs shortly after their entry into fattening units was examined. Ten groups of pigs with acute respiratory disease during the months September to October 1991 and seven groups of pigs with acute diarrhoea during the months February to March 1992 were investigated. On arrival in the fattening herds, more of the pigs were negative for antibodies against H1N1-influenza virus and against PRCV during September to October (61 and 50 per cent, respectively) than in February to March (51 and 34 per cent, respectively). There was serological evidence of a triple infection with PRCV and both influenza viruses in seven of the 17 groups; dual infections with PRCV and H1N1-influenza virus occurred in nine groups and with H1N1- and H3N2-influenza viruses in one group. Seroconversion against TGEV was not detected in any of the 17 groups, but seven of them had seroconverted to PEDV. Multiple infections with PRCV and either one or both of the influenza viruses were thus very common shortly after the introduction of feeder pigs into the fattening herds. There was no association between the type and/or multiplicity of these infections and respiratory disease, but infections with PEDV were clearly associated with outbreaks of diarrhoea.


Severe acute respiratory syndrome coronavirus phylogeny: toward consensus.


title: Mutations in the leucine zipper-like heptad repeat sequence of human immunodeficiency virus type 1 gp41 dominantly interfere with wild-type virus infectivity.

text: It has been previously shown that a proline substitution for any of the conserved leucine or isoleucine residues located in the leucine zipper-like heptad repeat sequence of human immunodeficiency virus type 1 (HIV-1) gp41 renders viruses noninfectious and envelope (Env) protein unable to mediate membrane fusion (S. S.-L. Chen, C.-N. Lee, W.-R. Lee, K. McIntosh, and T.-M. Lee, J. Virol. 67:3615-3619, 1993; S. S.-L. Chen, J. Virol. 68:2002-2010, 1994). To understand whether these variants could act as trans-dominant inhibitory mutants, the ability of these mutants to inhibit wild-type (wt) virus infectivity was examined. Comparable amounts of cell- and virion-associated gag gene products as well as virion-associated gp41 were found in transfection with wt or mutant HIV-1 provirus. Viruses obtained from coexpression of wt provirus with mutant 566 or 580 provirus inhibited more potently the production of infectious virus than did viruses generated from cotransfection of wt provirus with other mutant proviruses. Nevertheless, all viruses produced from mixed transfection showed decreased infectivity compared with that of the wt virus when a multinuclear-activation beta-galactosidase induction assay was performed. The ability of wt Env to induce cytopathic effects was inhibited by coexpression with mutant Env. Coexpression of mutants inhibited the ability of the wt protein to mediate virus-to-cell transmission, as demonstrated by an env trans-complementation assay with a defective HIV-1 proviral vector. These observations indicated that mutant Env, per se, interferes with wt Env function. Moreover, cotransfection of wt and mutant proviruses produced amounts of cell- and virion-associated gag gene products comparable to those produced by transfection of wt provirus. Similar amounts of gp41 were also found in virions generated from wt-mutant cotransfection as well as from wt transfection alone. These results indicated that the inhibitory effect conferred by mutants on the wt virus infectivity does not involve the late steps of Gag protein assembly and budding, but they suggest that the wt and mutant Env proteins form a dysfunctional hetero-oligomer which is impaired in an early step of the virus replication cycle. Our study demonstrates that mutations in the HIV-1 gp41 leucine zipper-like heptad repeat sequence dominantly inhibit infectious virus production.


Avian influenza and pandemics.