title: Vasoactive neuropeptides in clinical ophthalmology: An association with autoimmune retinopathy?

text: The mammalian eye is protected against pathogens and inflammation in a relatively immune-privileged environment. Stringent mechanisms are activated that regulate external injury, infection, and autoimmunity. The eye contains a variety of cells expressing vasoactive neuropeptides (VNs), and their receptors, located in the sclera, cornea, iris, ciliary body, ciliary process, and the retina. VNs are important activators of adenylate cyclase, deriving cyclic adenosine monophosphate (cAMP) from adenosine triphosphate (ATP). Impairment of VN function would arguably impede cAMP production and impede utilization of ATP. Thus VN autoimmunity may be an etiological factor in retinopathy involving perturbations of purinergic signaling. A sound blood supply is necessary for the existence and functional properties of the retina. This paper postulates that impairments in the endothelial barriers and the blood–retinal barrier, as well as certain inflammatory responses, may arise from disruption to VN function. Phosphodiesterase inhibitors and purinergic modulators may have a role in the treatment of postulated VN autoimmune retinopathy.


Colorectal cancer care in the age of coronavirus: strategies to reduce risk and maintain benefit


title: Synthesis and antiviral activity of sulfated and acetylated derivatives of 2β,3α-dihydroxy-5α-cholestane

text: Abstract Five new steroid sulfates, sodium 2β,3α-dihydroxy-5α-cholestane 3-sulfate (6), sodium 2β,3α-dihydroxy-5α-cholestane 2-sulfate (7), disodium 2β,3α-dihydroxy-5α-cholestane disulfate (8), sodium 3α-acetoxy-2β-hydroxy-5α-cholestane 2-sulfate (12), and sodium 2β-acetoxy-3α-hydroxy-5α-cholestane 3-sulfate (13), have been synthesized starting from 3β-hydroxy-5α-cholestane (1). The synthetic steroids were completely characterized by one-dimensional and two-dimensional NMR and FABMS spectra. Sulfation was performed using triethylamine–sulfur trioxide complex in dimethylformamide as the sulfating agent. The sulfated steroids were comparatively evaluated for their inhibitory effect on the replication of herpes simplex virus type 2 (HSV-2). Compounds 7 and 8 were the most effective in their inhibitory action against HSV-2. The disulfated steroid 8 also proved to be active against DEN-2 and JV.


title: A Case of SARS‐CoV‐2‐pneumonia with successful antiviral therapy in a 77‐year‐old male with heart transplant

text: The SARS‐CoV‐2‐infection can be seen as a single disease but also affects patients with relevant comorbidities who may have an increased risk of a severe course of infection. In this report, we present a 77‐year old patient with a heart transplant under relevant immunosuppressive therapy who was tested positive for SARS‐CoV‐2 after several days of dyspnoea, dry cough and light general symptoms. The CT‐scan confirmed an interstitial pneumonia. The patient received an antiviral therapy with hydroxychloroquine showing no further deterioration of the clinical state. After 12 days of hospitalisation the patient was released SARS‐CoV‐2 negative and completely asymptomatic.


title: COVID-19: What to do if you're worried about a child

text: Social distancing has become the new normal for many of us in our efforts to slow the spread of COVID-19 (Coronavirus) and protect our national healthcare service during the global crisis Adjusting to such an unfamiliar routine and, for many, being isolated from colleagues, friends and family at a time like this can be overwhelming, especially when it comes to essential matters such as safeguarding However, it's important to remember that you are not alone, and if you do find yourself worried about a child or vulnerable adult, there are steps you can take to reach out and safely share your concerns


title: Urticaria (angioedema) and COVID‐ 19 infection

text: The novel coronavirus, otherwise known as COVID‐19 has fast become a major health concern.(1 2) It has been reported that in addition to the conventional respiratory symptoms, patients also display skin manifestations such as Urticaria and angioedema.(3) Here we present a case study of an elderly man who first presented with generalised pruritic hives ranging from 1.5 to 8.0 cm in diameter on the 5(th) of March 2020. The patient was investigated for another differential diagnosis of Urticaria such as parasitic and bacterial infection, for which negative results were found. On the 5th of March 2020 the patient‐reported these symptoms plus general malaise, fatigue, 37.9⁰C temperature and sore throat. Initial biochemical tests showed that the patient presented with low numbers of white blood cells (WBC) (WBC=2.75x10(3)).


Preparing the Next Generation of African Healthcare Workers and Scientists: Lessons from Corona Virus Pandemic


title: COVID-19 Risk Assessment Tool: Dual application of risk communication and risk governance

text: Abstract Risk awareness is the best way to prevent and slow-down the transmission of the COVID-19 pandemic. Risk awareness is achieved through communication of risk assessment. Effective risk communication is an important measure to control the infodemic. Most risk assessment tools focus on either tracking the affected patients or diagnosing a probable health condition through symptoms. RIKA India introduces an innovative Risk Assessment Tool which goes beyond the symptom detection and patient tracking. It includes four factors in assessment of risk: Health, Behaviour, Exposure and Social Policy. Each of these four factors have sub-factors which help to assess the overall risk in a more comprehensive way and also present it to the user in a simplified way. The paper discusses the importance of the Risk Assessment Tool for awareness generation and decision making. Further, the datasets generated through the tool have been analysed to understand the key intervention areas for COVID-19 response and management.


title: Dataset of Ex-pat Teachers in Southeast Asia's Intention to Leave due to the COVID-19 pandemic

text: The COVID-19 pandemic exerted an adverse influence on the global education system, especially since starting school lockdown. The growth of teacher unemployment figures climbed double-digit and spawned these unexpected sequels. For instance, while native teachers seemed indisposed to leave the profession with the aim of seeking another more profited and seasonal jobs, many ex-pat teachers presented themselves with moving or stayed dilemma in the way the government salvaged their situation. In preference with the ex-pat teacher's case, we elucidated further throughout an e-survey in the International Baccalaureate community on Facebook from 4 to 11 April 2020 for 18,000 ex-pat teachers, who are teaching at Southeast Asia. This dataset includes 307 responses of ex-pat teachers who are staying in Singapore, Thailand, Vietnam, the Philippines, and Indonesia during the pandemic. The dataset comprises (i) Survey partakers' Demographics; (ii) Ex-pat teachers' perceptions in the relation of national, regional and school plans were afoot to the pandemic; (iii) The degree of attachment of ex-pat teacher to their current society, the ex-pat community, friends, and families during the pandemic time; (iv) Ex-pat teachers' embryo intention to reconsider their current teaching location.


title: Expatriates’ Multiple Fears, from Terrorism to Working Conditions: Development of a Model

text: Companies’ internationalization appears to be fundamental in the current globalized and competitive environment and seems important not only for organizational success, but also for societal development and sustainability. On one hand, global business increases the demand for managers for international assignment. On the other hand, emergent fears, such as terrorism, seem to be developing around the world, enhancing the risk of expatriates’ potential health problems. The purpose of this paper is to examine the relationships between the emergent concept of fear of expatriation with further workplace fears (economic crisis and dangerous working conditions) and with mental health problems. The study uses a quantitative design. Self-reported data were collected from 265 Italian expatriate workers assigned to both Italian and worldwide projects. Structural equation model analyses showed that fear of expatriation mediates the relationship of mental health with fear of economic crisis and with perceived dangerous working conditions. As expected, in addition to fear, worries of expatriation are also related to further fears. Although, the study is based on self-reports and the cross-sectional study design limits the possibility of making causal inferences, the new constructs introduced add to previous research.


title: How Incivility and Academic Stress Influence Psychological Health among College Students: The Moderating Role of Gratitude

text: Many students suffer from academic stress and uncivil behaviors at colleges and there is a need to identify to what extent these negative phenomena might impact students’ mental health. The main purpose of this study is to examine the relationships between incivility, academic stress, and psychological health, as well as investigate the moderating role of gratitude. The study design of this research is cross-sectional. The final sample consisted of 895 university students in China; The Statistical Package for the Social Sciences (SPSS) version 22 was utilized to conduct statistical analysis. Sample t-tests were used to examine whether there were gender differences in terms of four continuous variables: incivility, stress, gratitude, and psychological wellbeing. We also used multiple hierarchical linear regression analysis to test the relationships between the aforementioned four variables and the moderating effect of gratitude. The results of our study indicate that academic stress and incivility are positively associated with psychological distress, and gratitude moderates the relationship between incivility and psychological distress. However, no significant moderating effect of gratitude was found in the relationship between academic stress and psychological distress.


docid: zsdyvqfb

title: From Hematologistʼs desk: The effect of COVID‐19 on the blood system


title: Chest computed tomography findings of COVID-19 pneumonia: pictorial essay with literature review

text: Available information on chest Computed Tomography (CT) findings of the 2019 novel coronavirus disease (COVID-19) is constantly evolving. Ground glass opacities and consolidation with bilateral and peripheral distribution were reported as the most common CT findings, but also less typical features could be identified. All radiologists should be aware of the imaging spectrum of the COVID-19 pneumonia and imaging changes in the course of the disease. Our aim is to display the chest CT findings at first assessment and follow-up through a pictorial essay, to help in the recognition of these features for an accurate diagnosis. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11604-020-01010-7) contains supplementary material, which is available to authorized users.


title: Transshipment hub selection from a shipper's and freight forwarder's perspective

text: Abstract Transshipment hub selection becomes increasingly important to the global logistics community. From the perspectives of shippers and freight forwarders, a selection must align with cost control strategy and sustain service reliability across cooperative service providers. This paper assesses the selection with the options of both sea and air transports, and from the influence of country of origin of the company. Critical factors of transshipment hub selection, both qualitative and quantitative, are identified through focus group discussions. Relative importance of these factors is determined based on collective views of logistics stakeholders. The competitiveness of transshipment hubs is then assessed using an AHP approach. Our analysis is based on the historical implementation of direct transportation link policy between Mainland China and Taiwan. With this empirical work, the finding suggests that even the spawn of other nearby ports with shorter transport distance and closer proximity to cargo sources, there remain overriding factors such as customs regulations & government policies and connectivity that a transshipment hub is preferred.


docid: slkivxdo

title: High Incidence of Multiple Viral Infections Identified in Upper Respiratory Tract Infected Children under Three Years of Age in Shanghai, China

text: BACKGROUND: Upper respiratory tract infection (URTI) is a major reason for hospitalization in childhood. More than 80% of URTIs are viral. Etiological diagnosis of URTIs is important to make correct clinical decisions on treatment methods. However, data for viral spectrum of URTIs are very limited in Shanghai children. METHODS: Nasopharyngeal swabs were collected from a group of 164 children aged below 3 years who were hospitalized due to acute respiratory infection from May 2009 to July 2010 in Shanghai. A VRDAL multiplex PCR for 10 common respiratory viruses was performed on collected specimens compared with the Seeplex® RV15 ACE Detection kit for 15 respiratory viruses. RESULTS: Viruses were detected in 84 (51.2%) patients by VRDAL multiplex PCR, and 8 (4.9%) of cases were mixed infections. Using the Seeplex® RV15 ACE Detection kit, viruses were detected in 129 (78.7%) patients, 49 (29.9%) were co-infected cases. Identified viruses included 37 of human rhinovirus (22.6% of cases), 32 of influenza A virus (19.5%), 30 of parainfluenzavirus-2 (18.3%), 23 of parainfluenzavirus-3 (14.0%), 15 of human enterovirus (9.1%), 14 each of parainfluenzavirus-1, respiratory syncytial virus B and adenovirus (8.5%), 8 of coronavirus 229E/NL63 (4.9%), 6 of human bocavirus (3.7%), 5 each of influenza B virus and respiratory syncytial virus A (3.0%), 3 of parainfluenzavirus-4 (1.8%), 2 of coronavirus OC43/HKU1 (1.2%), and 1 human metapneumovirus (0.6%). CONCLUSIONS: A high frequency of respiratory infections (78.7%) and co-infections (29.9%) was detected in children with acute respiratory infection symptoms in Shanghai. The Seeplex® RV15 ACE detection method was found to be a more reliable high throughput tool than VRDAL method to simultaneously detect multiple respiratory viruses.


Severe acute respiratory illness pandemics: coronavirus disease 2019 and other viral etiologies in the 21st century


Is novel coronavirus disease (COVID‐19) transmitted through conjunctiva?


title: Prevalence of preventive behaviors and associated factors during early phase of the H1N1 influenza epidemic

text: BACKGROUND: The community plays an important role in controlling influenza A/H1N1. There is a dearth of data investigating adoption of preventive behaviors in the initial phase of the A/H1N1 pandemic. METHODS: Three round of random, population-based, anonymous telephone survey were conducted in Hong Kong during the pre-community outbreak phase (May 7 to June 6, 2009) of the influenza A/H1N1 pandemic in Hong Kong (n = 999). RESULTS: Respectively, 46.65%, 88.75%, and 21.5% washed hands more than 10 times/day, wore face masks when having influenza-like illness (ILI), and wore face masks regularly in public areas. Perceptions related to bodily damages, efficacy of frequent handwashing, nonavailability of effective vaccines, high chance of having a large scale local outbreak, and mental distress because of influenza A/H1N1 were associated with frequent handwashing (odds ratio [OR], 1.46 to 2.15). Perceived vaccine availability was associated with face mask use when having ILI (OR, 1.60). Perceived fatality, efficacy of wearing face masks, and mental distress because of influenza A/H1N1 were associated with face mask use in public areas (OR, 1.53 to 2.52). CONCLUSION: Preventive behaviors were prevalently adopted by the public and were associated with cognitive and affective factors. Prevention efforts should take public perceptions into account, and emerging infectious diseases provide good chances for promoting hygiene.


title: Low Titer Pneumocystis jirovecii Infections: More than Just Colonization?

text: Non-pneumonia Pneumocystis jirovecii colonization is thought to occur frequently in immunocompetent individuals. The aim was to analyze if P. jirovecii low-titer detections have more impact than just colonization. From our total cohort of patients for which P. jirovecii testing by qPCR was requested, we selected exclusively those that were fully immunocompetent. Patients were defined as fully immunocompetent if they did not receive immunosuppressive therapy, displayed regular antibody titers, and did not suffer from acquired, inherited or autoimmune diseases. Only those patients with complete medical records available were included. A retrospective analysis identified patients with P. jirovecii colonization and successful antibiotic therapy in response to laboratory pathogen detection. We identified 30 fully immunocompetent patients with P. jirovecii colonization suspected to suffer from infection with the pathogen, but with milder symptoms than pneumonia. All patients were successfully treated with cotrimoxazole against P. jirovecii and resolved from chronic cough and recurrent pulmonary infections. The fact that all patients displayed recovery from their clinical symptoms gives raise to the hypothesis that P. jirovecii infections may also occur in immunocompetent patients but with milder symptoms.


title: A novel clustering method via nucleotide-based Fourier power spectrum analysis

text: Abstract A novel clustering method is proposed to classify genes or genomes. This method uses a natural representation of genomic data by binary indicator sequences of each nucleotide (adenine (A), cytosine (C), guanine (G), and thymine (T)). Afterwards, the discrete Fourier transform is applied to these indicator sequences to calculate spectra of the nucleotides. Mathematical moments are calculated for each of these spectra to create a multidimensional vector in a Euclidean space for each gene or genome sequence. Thus, each gene or genome sequence is realized as a geometric point in the Euclidean space. Finally, pairwise Euclidean distances between these points (i.e. genome sequences) are calculated to cluster the gene or genome sequences. This method is applied to three sets of data. The first is 34 strains of coronavirus genomic data, the second is 118 of the known strains of Human rhinovirus (HRV), and the third is 30 bacteria genomes. The distance matrices are computed based on the three sets, showing the distances from each point to the others. We used the complete linkage clustering algorithm to build phylogenetic trees to indicate how the distances among these sequence correspond to the evolutionary relationship among these sequences. This genome representation provides a powerful and efficient method to classify genomes and is much faster than the widely acknowledged multiple sequence alignment method.


Miller–Fisher-like syndrome related to SARS-CoV-2 infection (COVID 19)


title: Increased Detection of Viruses in Children with Respiratory Tract Infection Using PCR

text: Respiratory viruses are a common cause of respiratory tract infection (RTI), particularly in neonates and children. Rapid and accurate diagnosis of viral infections could improve clinical outcomes and reduce the use of antibiotics and treatment sessions. Advances in diagnostic technology contribute to the accurate detection of viruses. We performed a multiplex real-time polymerase chain reaction (PCR) to investigate the viral etiology in pediatric patients and compared the detection rates with those determined using traditional antigen tests and virus cultures. Fifteen respiratory viruses were included in our investigation: respiratory syncytial virus A/B (RSV), influenza virus A (FluA) and influenza virus B (FluB), human metapneumovirus (MPV), enterovirus (EV), human parainfluenza virus (PIV) types 1–4, human rhinovirus (RV), human coronavirus OC43, NL63, and 229E, human adenovirus (ADV), and human bocavirus (Boca). In total, 474 specimens were collected and tested. Respiratory viruses were detected more frequently by PCR (357, 75.3%) than they were by traditional tests (229, 49.3%). The leading pathogens were RSV (113, 23.8%), RV (72, 15.2%), PIV3 (53, 11.2%), FluA (51, 10.8%), and ADV (48, 10.1%). For children younger than 5 years, RSV and RV were most prevalent; for children older than 5 years, FluA and ADV were the most frequently detected. Of the specimens, 25.8% (92/357) were coinfected with two or more viruses. RV, Boca, PIV2, FluB, and PIV4 had higher rates of coinfection; MPV and PIV1 had the lowest rates of coinfection (9.1% and 5.3%). To conclude, the detection power of PCR was better than that of traditional antigen tests and virus cultures when considering the detection of respiratory viruses. RSV and RV were the leading viral pathogens identified in the respiratory specimens. One-quarter of the positive specimens were coinfected with two or more viruses. In the future, further application of PCR may contribute to the rapid and accurate diagnosis of respiratory viruses and could improve patient outcomes.


title: High incidence of human bocavirus infection in children in Spain

text: Abstract Background The newly identified human bocavirus (HBoV), a member of the Parvoviridae family, has been associated to low respiratory tract infections in young children. Objectives To present the epidemiological profile and the main clinical characteristics showed by children infected with this virus in Spain. Study design We have studied the incidence of HBoV and other 15 respiratory viruses in 917 nasopharyngeal aspirates taken from 730 infants and children under age of 14 with acute lower respiratory tract infection from September-04 to August-06. Results HBoV was detected in 123 samples (13.4%) showing a seasonal distribution with November and December as the peak months. Out of the 558 samples which rendered a positive result for at least one of the virus tested, HBoV (22%) ranked fourth behind respiratory syncytial virus (181, 32%), adenoviruses (155, 28%) and rhinoviruses (136, 24%). Co-infections with HBoV and other respiratory viruses were detected in 74 out of 123 HBoV-positive specimens (60%). In addition, HBoV was also found in stool and, for the first time, in urine samples. Conclusions Results obtained provide further evidence that HBoV is involved in acute lower respiratory tract infections. HBoV-associated disease should not be limited to the respiratory tract.


docid: mffdqugd

title: Retour à l’école et COVID-19 : il est urgent de maîtriser nos peurs et aller de l’avant pour le bien des enfants: Tribune


title: Evaluation of the 2017/18 Influenza Epidemic Season in Poland Based on the SENTINEL Surveillance System

text: The SENTINEL influenza surveillance system is an important tool for monitoring influenza in Poland. Data from this system are necessary to determine the dynamics of seasonal infections and to announce the epidemic by the country level. For the 2017/18 epidemic season, the dominance of influenza type B was recorded and the highest percentage of infections was recorded in the age group 45–64 years. Among the subtypes of influenza type A, A/H1N1/pdm09 was the predominated subtype. Most cases were reported in the age group of 26–44 and 0–4 years. The influenza virus frequently undergoes modifications. Therefore, it is necessary to constantly monitor the emerging strains around the world.


docid: ocrfclzj

title: Extraneous agent detection in vaccines − A review of technical aspects

text: Abstract The quality and safety of commercial vaccines have a profound importance. Contrary to all precautions and efforts the use of biological material in vaccine development and production may lead to potential contamination of the vaccines with known and unknown extraneous agents (EAs). In veterinary field official lists of EAs have been compiled as legal framework to describe the potential agents, which must be tested during manufacture of vaccines. Nevertheless, detection of known and unknown contaminants in vaccines is a common duty for manufacturers and authorities of both veterinary and human field sharing similar needs of special technical approaches. State-of-art molecular methods such as randomly primed PCR combined with massive parallel sequencing (MPS) or microarrays may open new perspectives in extraneous agent testing. The robustness and efficacy of this technical approach in vaccine control was clearly demonstrated on a human vaccine example when porcine circovirus type 1 (PCV1) contamination was revealed in Rotarix, a human rotavirus vaccine. The consequences and implications are reviewed hereby from a veterinary regulatory point of view.


Venezuelan migrants “struggling to survive” amid COVID-19


title: The role of ecosystems in mitigation and management of Covid-19 and other zoonoses

text: There is rising international concern about the zoonotic origins of many global pandemics. Increasing human-animal interactions are perceived as driving factors in pathogen transfer, emphasising the close relationships between human, animal and environmental health. Contemporary livelihood and market patterns tend to degrade ecosystems and their services, driving a cycle of degradation in increasingly tightly linked socio-ecological systems. This contributes to reductions in the natural regulating capacities of ecosystem services to limit disease transfer from animals to humans. It also undermines natural resource availability, compromising measures such as washing and sanitation that may be key to managing subsequent human-to-human disease transmission. Human activities driving this degrading cycle tend to convert beneficial ecosystem service into disservices, exacerbating risks related to zoonotic diseases. Conversely, measures to protect or restore ecosystems constitute investment in foundational capital, enhancing their capacities to provide for greater human security and opportunity. We use the DPSIR (Drivers-Pressures-State change-Impact-Response) framework to explore three aspects of zoonotic diseases: (1) the significance of disease regulation ecosystem services and their degradation in the emergence of Covid-19 and other zoonotic diseases, and of the protection of natural resources as mitigating contributions to both; (2) regulating human-to-human disease transfer; and (3) treatment of disease outbreaks. From this analysis, we identify a set of appropriate response options, recognising the foundational roles of ecosystems and the services they provide in risk management. Zoonotic disease risks are ultimately interlinked with biodiversity crises and water insecurity. The need to respond to the Covid-19 pandemic ongoing at the time of writing creates an opportunity for systemic policy change, placing scientific knowledge of the value and services of ecosystems at the heart of societal concerns as a key foundation for a more secure future. Rapid political responses and unprecedented economic stimuli reacting to the pandemic demonstrate that systemic change is achievable at scale and pace, and is also therefore transferrable to other existential, global-scale threats including climate change and the ‘biodiversity crisis’. This also highlights the need for concerted global action, and is also consistent with the duties, and ultimately the self-interests, of developed, donor nations.


docid: pwxprzha

title: Managing Patients with Multiple Myeloma during the COVID-19 Pandemic: Recommendations from an Expert Panel – ABHH Monoclonal Gammopathies Committe

text: Abstract Since the World has been facing the COVID-19 pandemic, special attention has been taken concerning cancer patients; related to their immunosuppression status, adding risk for more aggressive COVID-19 and mortality, but also concerns about the access and the quality of care in cancer therapy. The COVID-19 pandemic impacts the number of infected, its related mortality, as well as the care of cancer patients. Multiple myeloma patients are a particular group with several important aspects to be considered during pandemic times. In essence, they are immunosuppressed in different intensities during their treatment. Most of them are elderly and all of them require long-term therapy, with prolonged contact with the health care system, possibly including a stem cell transplant during the treatment. A panel of experts in multiple myeloma and infectious diseases discusses pieces of evidence and the lack of the same in the scenario of COVID-19 in myeloma patients, while also exposing what is expected for the next phases of the COVID-19 pandemic.


title: Tocilizumab for treatment of patients with severe COVID–19: A retrospective cohort study

text: BACKGROUND: Tocilizumab was approved for chimeric antigen receptor T–cell therapy induced cytokine release syndrome and it may provide clinical benefit for selected COVID–19 patients. METHODS: In this retrospective cohort study, we analyzed hypoxic COVID–19 patients who were consecutively admitted between March 13, 2020 and April 19, 2020. Patients with lung infiltrates and elevated inflammatory markers received a single dose of tocilizumab if no contraindication was present. Systemic steroid, hydroxychloroquine, and azithromycin were concomitantly used for majority of the patients. FINDINGS: Of the 51 patients included for analysis, 28 (55%) received tocilizumab and 23 (45%) did not receive tocilizumab. Tocilizumab cohort required more invasive ventilation (68% vs. 22%) at baseline and during entire hospitalization (75% vs. 48%). The median time to clinical improvement in tocilizumab vs. no tocilizumab cohorts was 8 days (Interquartile range [IQR]: 6·25 – 9·75 days) vs. 13 days (IQR: 9·75 – 15·25 days) among patients who required mechanical ventilation at any time (Hazard ratio for clinical improvement: 1·83, 95% confidence interval [CI]: 0·57 – 5·84) and 6·5 days vs. 7 days among all patients (Hazard ratio for clinical improvement: 1·14, 95% CI: 0·55 – 2·38), respectively. The median duration of vasopressor support and invasive mechanical ventilation were 2 days (IQR: 1·75 – 4·25 days) vs. 5 days (IQR: 4 – 8 days), p = 0.039, and 7 days (IQR: 4 – 14 days) vs. 10 days (IQR: 5 – 15 days) in tocilizumab vs. no tocilizumab cohorts, p = 0.11, respectively. Similar rates of hospital–acquired infections occurred in both cohorts (18% in tocilizumab and 22% in no tocilizumab cohort). INTERPRETATION: In patients with severe COVID-19, tocilizumab was associated with significantly shorter duration of vasopressor support. Although not statistically significant, tocilizumab also resulted in shorter median time to clinical improvement and shorter duration of invasive ventilation. These findings require validation from ongoing clinical trials of Tocilizumab in COVID–19 patients.


title: Meeting the Challenge of Influenza Pandemic Preparedness in Developing Countries

text: Developing countries face unique difficulties preparing for an influenza pandemic. Our current top-down approach will not provide these countries with adequate supplies of vaccines and antiviral agents. Consequently, they will have to use a bottom-up approach based on inexpensive generic agents that either modify the host response to influenza virus or act as antiviral agents. Several of these agents have shown promise, and many are currently produced in developing countries. Investigators must primarily identify agents for managing infection in populations and not simply seek explanations for how they work. They must determine in which countries these agents are produced and define patterns of distribution and costs. Because prepandemic research cannot establish whether these agents will be effective in a pandemic, randomized controlled trials must begin immediately after a new pandemic virus has emerged. Without this research, industrialized and developing countries could face an unprecedented health crisis.


title: Infectious disease transmission: survey of contacts between hospital-based healthcare workers and working adults from the general population

text: Summary Background Healthcare workers (HCWs) may be the inadvertent interface between the healthcare setting and the community for infectious diseases transmission. Aim To investigate HCWs' contacts during a work day and compare these against working adults from the general population. Methods Prospective survey of contacts through 24 h self-reported diary in three public sector tertiary care hospitals and community-based working adults in Singapore. Participants were HCWs and working adults from the community. Findings In all, 211 HCWs and 1028 working adults reported a total of 4066 and 9206 contacts. HCWs reported more work-related contacts than community-based working adults (median of 13 versus 4), and more contacts that were neither household nor work-related (1 versus 0) but fewer household contacts (2 versus 3). HCWs reported more work-related contacts involving physical contacts, and more new contacts particularly with short duration (≤15 min) compared to community-based working adults. Among different HCW types, doctors reported the highest whereas ward-based nurses reported the lowest total work-related contacts. Around half of ward-based and clinic-based nurses' contacts involved physical touch. Work-related contacts reported by clinic-based nurses, doctors, and assorted HCWs were shorter than in ward-based nurses, with a substantial number effectively occurring with new contacts. Institutional effects significant on univariate analyses were much reduced and non-significant after adjusting for confounding by HCW type. Conclusion HCWs' contacts differ substantially from those of community-based working adults. HCWs may thus be at higher risk of acquiring and spreading contact-transmissible and respiratory infections due to the nature of their work. Whereas total number of contacts was fairly similar between HCW types, the characteristics of their contacts differed substantively.


title: Temporary carriage of bovine coronavirus and bovine respiratory syncytial virus by fomites and human nasal mucosa after exposure to infected calves

text: BACKGROUND: In order to prevent spread of the endemic pathogens bovine coronavirus (BCoV) and bovine respiratory syncytial virus (BRSV) between herds, knowledge of indirect transmission by personnel and fomites is fundamental. The aims of the study were to determine the duration of viral RNA carriage and the infectivity of viral particles on fomites and human nasal mucosa after exposure to BCoV and BRSV. During two animal infection experiments, swabs were collected from personnel (nasal mucosa) and their clothes, boots and equipment after contact with calves shedding either virus. Viral RNA was quantified by RT-qPCR or droplet digital RT-PCR (RT-ddPCR), and selected samples with high levels of viral RNA were tested by cell culture for infectivity. RESULTS: For BCoV, 46% (n = 80) of the swabs from human nasal mucosa collected 30 min after exposure were positive by RT-qPCR. After two, four and six hours, 15%, 5% and 0% of the swabs were positive, respectively. Infective virions were not detected in mucosal swabs (n = 2). A high viral RNA load was detected on 97% (n = 44) of the fomites 24 h after exposure, and infective virions were detected in two of three swabs. For BRSV, 35% (n = 26) of the human nasal mucosa swabs collected 30 min after exposure, were positive by RT-ddPCR, but none were positive for infective virions. Of the fomites, 89% (n = 38) were positive for BRSV RNA 24 h after exposure, but all were negative for infective viruses. CONCLUSIONS: The results indicate that human nasal mucosa can carry both BCoV and BRSV RNA after exposure to virus shedding calves, but the carriage seems short-lived and the transmission potential is likely limited. High viral loads on contaminates fomites 24 h after exposure to infected animals, and detection of infective BCoV, indicate that contaminated fomites represent a significant risk for indirect transmission between herds.


title: Skin cancer triage and management during COVID‐19 pandemic

text: The worldwide medical community is striving to pursue the most appropriate clinical choices in the worst event of pandemic of the modern times [1], with over 1 million patients affected by COVID‐19 (i.e., swab positive patients with or without symptoms) reported so far [1]. In this context, the aim of the ideal management of cancer patients is to achieve the best possible balance between the two different issues to be considered, which include the risk of cancer progression and the risk of infectious disease.


title: Chest radiographs and CTs in the era of COVID-19: indications, operational safety considerations and alternative imaging practices

text: Coronavirus Disease-19 (COVID-19) is a pathogen that has shown an ability for sustained community transmission. Radiology services will need to adapt to cope with this disease in the coming months and possibly years ahead. This includes learning how to perform radiographs and CT in a safe and sustainable manner. Due to the risk of nosocomial spread of disease, the judicious use and implementation of strict infection protocols is paramount to limit healthcare worker and patient transmission. Between 28 January 2020 and 8 June 2020, our institution performed 12034 radiographs and 178 CT scans for suspected or confirmed COVID-19 patients. As of 8 June 2020, there have been no documented instances of healthcare staff acquiring COVID-19 in the course of work. In this article, we present the indications and operational considerations used by our institution to safely image patients with suspected or confirmed COVID-19. Alternative practices for imaging radiographs are also discussed.


title: End of Life Care in Individuals with Serious Mental Illness

text: BACKGROUND: Approximately 4.5% of the population live with serious mental illness (SMI), a term referring to mental health disorders that are chronic, impair function, and require ongoing treatment. People living with SMI are at risk of premature mortality relative to people without SMI. Chronic medical illnesses contribute significantly to mortality among individuals with SMI. The standard of care for individuals with serious medical illnesses includes palliative care. However, the provision of palliative care has not been operationalized for individuals with SMI. OBJECTIVE/METHODS: This narrative review presents existing epidemiologic data on end-of-life (EOL) care and palliative care for individuals with comorbid serious medical illness and SMI. Challenges in the care of such patients are discussed. The role of the consultation-liaison psychiatrist in providing EOL care for individuals with SMI is delineated with an eye towards redressing disparities. RESULTS: Individuals with SMI are at risk of sub-optimal end-of-life care. Patient, clinician, and system-level factors all contribute to disparities including decreased access to palliative care, uneven continued engagement with mental health services, and low rates of advance care planning. CL psychiatrists can use their expertise at the intersection of medicine and psychiatry to address such disparities by (1) correcting misassumptions, (2) promoting advance care planning, (3) engaging long-term caregivers, (4) recognizing social needs, (5) ensuring ongoing access to psychiatric treatment, and (6) addressing suffering. CONCLUSIONS: There are significant disparities in the end-of-life care of individuals with SMI. CL psychiatrists have expertise to ally with medical providers and redress these disparities.


title: Awareness of MERS-CoV among Staff Members of Prince Sultan Military Medical City in Riyadh, Saudi Arabia

text: Background The Middle East respiratory syndrome coronavirus (MERS-CoV) developed infections that caused serious epidemics. Special priority of awareness and prompt initiative involvement of health workers (HW) during such intensified health situation necessitated an assessment of their preparedness, appropriate attitudes and protective strategies for better efficiency modes and acceleration during emergency. Methods HW of Prince Sultan Military Medical city in Riyadh, Saudi Arabia were reviewed through specifically designed questionnaires to acquire the demanded data. It included clinical and demographic information about the viral diseases, associated signs and symptoms, transmission and protection, and attitudes about the MERS-CoV disease. Results The study was accomplished between August and November, 2017 and 477 participants of the medical city, successfully completed the study questionnaire (Appendix I). Females represented a majority and there was an indirectly proportional decrease with the increasing age. Gradual educational increase levels reflected dominance of the university degree holders. Jobs were dominated by nurses and non-Saudis were a majority whilst, the highly experienced, (>10 years) were a minority. A majority recognized the viral transmission methods, popular information sources of MERS-CoV and associated medical terms. Highest scores were observed in dealing with protective aids and recognizing symptoms of disease. High adherence to hand hygiene protocols and correct washing steps were recorded. Correct and high levels were observed in taking preventive measures and avoiding infection. Participants responded correctly to negative and wrong actions that patients should refrain from. High scores were observed in taking appreciable attitudes towards oneself and towards others. Conclusions Expatriates were majority and nurses were dominant which, necessitates Saudization of this sector. Ministry of health pamphlets and seminars were of less impact in invigilating HW, hence, more attention and efforts are demanded. HW were quite aware of the basic and emergent health policies during epidemic episodes of MERS-CoV.


title: Chest Imaging in Patients Hospitalized With COVID-19 Infection - A Case Series

text: Abstract COVID-19 (Corona Virus Disease-19) is a zoonotic illness first reported in the city of Wuhan, China in December 2019, and is now officially a global pandemic as declared by the World Health Organization. The infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 infected patients can be asymptomatic carriers or present with mild-to-severe respiratory symptoms. Imaging, including computed tomography is not recommended to screen/diagnose COVID-19 infections, but plays an important role in management of these patients, and to rule out alternative diagnoses or coexistent diseases. In our multicenter case series, we outline the clinical presentations and illustrate the most common imaging manifestations in patients hospitalized with COVID-19.


title: What to Expect When You’re Expecting Zika

text: The 2015 emergence of Zika virus (ZIKV) in the Americas brought new attention to this previously obscure virus. Experimental model systems have been instrumental in rapidly advancing our understanding of ZIKV pathogenesis. Here, Lazear looks back on the events leading to the development of the ZIKV mouse model reported in Cell Host & Microbe.


title: Sequencing and molecular modeling identifies candidate members of Caliciviridae family in bats

text: Abstract Emerging viral diseases represent an ongoing challenge for globalized world and bats constitute an immense, partially explored, reservoir of potentially zoonotic viruses. Caliciviruses are important human and animal pathogens and, as observed for human noroviruses, they may impact on human health on a global scale. By screening fecal samples of bats in Hungary, calicivirus RNA was identified in the samples of Myotis daubentonii and Eptesicus serotinus bats. In order to characterize more in detail the bat caliciviruses, large portions of the genome sequence of the viruses were determined. Phylogenetic analyses and molecular modeling identified firmly the two viruses as candidate members within the Caliciviridae family, with one calicivirus strain resembling members of the Sapovirus genus and the other bat calicivirus being more related to porcine caliciviruses of the proposed genus Valovirus. This data serves the effort for detecting reservoir hosts for potential emerging viruses and recognize important evolutionary relationships.


Commentary: McIntosh K, Chao RK, Krause HE, Wasil R, Mocega HE, Mufson MA. Coronavirus Infection in Acute Lower Respiratory Tract Disease of Infants. J Infect Dis 1974;130:502–7.


title: A role for CD8+ T lymphocytes in the pathogenesis of AIDS

text: Abstract Experimental and clinical evidence is presented which supports the hypothesis that CD8+ T lymphocytes aimed at suppressing HIV replication in infected CD4+ T cells may have an important role in the pathogenesis of AIDS by directly causing a decrease in CD4+ T lymphocyte numbers. Possible models to test this hypothesis are discussed.


title: Impact of COVID-19 pandemic on pre-existing mental health problems

text: • Relapse rates of all pre-existing mental health problems are commonly seen to be increased during COVID 19. • Quarantine is a stressful situation which increases psychiatric morbidity through many different pathways. • Policy changes which can promote tele-psychiatric services will play significant role in during the pandemic.


title: Fish Oil-Fed Mice Have Impaired Resistance to Influenza Infection

text: Dietary fish oils, rich in (n-3) PUFA, including eicosapentaenoic acid and docosahexaenoic acid, have been shown to have antiinflammatory properties. Although the antiinflammatory properties of fish oil may be beneficial during a chronic inflammatory illness, the same antiinflammatory properties can suppress the inflammatory responses necessary to combat acute viral infection. Given that (n-3) fatty acid-rich fish oil supplementation is on the rise and with the increasing threat of an influenza pandemic, we tested the effect of fish oil feeding for 2 wk on the immune response to influenza virus infection. Male C57BL/6 mice fed either a menhaden fish oil/corn oil diet (4 g fish oil:1 g corn oil, wt:wt at 5 g/100 g diet) or a control corn oil diet were infected with influenza A/PuertoRico/8/34 and analyzed for lung pathology and immune function. Although fish oil-fed mice had lower lung inflammation compared with controls, fish oil feeding also resulted in a 40% higher mortality rate, a 70% higher lung viral load at d 7 post infection, and a prolonged recovery period following infection. Although splenic natural killer (NK) cell activity was suppressed in fish oil-fed mice, lung NK activity was not affected. Additionally, lungs of infected fish oil-fed mice had significantly fewer CD8(+) T cells and decreased mRNA expression of macrophage inflammatory protein-1-α, tumor necrosis factor-α, and interleukin-6. These results suggest that the antiinflammatory properties of fish oil feeding can alter the immune response to influenza infection, resulting in increased morbidity and mortality.


title: Household‐level risk factors for secondary influenza‐like illness in a rural area of Bangladesh

text: OBJECTIVE: To describe household‐level risk factors for secondary influenza‐like illness (ILI), an important public health concern in the low‐income population of Bangladesh. METHODS: Secondary analysis of control participants in a randomised controlled trial evaluating the effect of handwashing to prevent household ILI transmission. We recruited index‐case patients with ILI – fever (<5 years); fever, cough or sore throat (≥5 years) – from health facilities, collected information on household factors and conducted syndromic surveillance among household contacts for 10 days after resolution of index‐case patients’ symptoms. We evaluated the associations between household factors at baseline and secondary ILI among household contacts using negative binomial regression, accounting for clustering by household. RESULTS: Our sample was 1491 household contacts of 184 index‐case patients. Seventy‐one percentage reported that smoking occurred in their home, 27% shared a latrine with one other household and 36% shared a latrine with >1 other household. A total of 114 household contacts (7.6%) had symptoms of ILI during follow‐up. Smoking in the home (RR (adj) 1.9, 95% CI: 1.2, 3.0) and sharing a latrine with one household (RR (adj) 2.1, 95% CI: 1.2, 3.6) or >1 household (RR (adj) 3.1, 95% CI: 1.8–5.2) were independently associated with increased risk of secondary ILI. CONCLUSION: Tobacco use in homes could increase respiratory illness in Bangladesh. The mechanism between use of shared latrines and household ILI transmission is not clear. It is possible that respiratory pathogens could be transmitted through faecal contact or contaminated fomites in shared latrines.


A TALE OF TWO CITIES: INSIGHT AND PRACTICAL CONSIDERATIONS DURING THE COVID PANDEMIC.


title: Sequence mismatch in PCR probes may mask the COVID-19 detection in Nepal

text: • Most of the COVID-19 cases in Nepal are in the Southern districts of Nepal bordering India with travel histories to India. • Very few positive cases of COVID-19 are detected in Nepal which could either be due to early national lockdown. • Low PCR positivity rates could also be due to inefficiency of the PCR methods. • Whole genomes of 93 clinical samples from COVID-19 patients were analyzed to find the primer and probe binding sites. • Mutations in probe binding sites were found which could impact PCR efficiency resulting in false negative results.


title: Prevention of hospital-acquired infections: review of non-pharmacological interventions

text: Summary Hospital-acquired (nosocomial) infections (HAIs) increase morbidity, mortality and medical costs. In the USA alone, nosocomial infections cause about 1.7 million infections and 99 000 deaths per year. HAIs are spread by numerous routes including surfaces (especially hands), air, water, intravenous routes, oral routes and through surgery. Interventions such as proper hand and surface cleaning, better nutrition, sufficient numbers of nurses, better ventilator management, use of coated urinary and central venous catheters and use of high-efficiency particulate air (HEPA) filters have all been associated with significantly lower nosocomial infection rates. Multiple infection control techniques and strategies simultaneously (‘bundling’) may offer the best opportunity to reduce the morbidity and mortality toll of HAIs. Most of these infection control strategies will more than pay for themselves by saving the medical costs associated with nosocomial infections. Many non-pharmacological interventions to prevent many HAIs will also reduce the need for long or multiple-drug antibiotic courses for patients. Lower antibiotic drug usage will reduce risk of antibiotic-resistant organisms and should improve efficacy of antibiotics given to patients who do acquire infections.


title: A Comprehensive Updated Review on SARS‐CoV‐2 and COVID‐19

text: This literature review aims to provide a comprehensive current summary of the pathogenesis, clinical features, disease course, host immune responses, and current investigational antiviral and immunomodulatory pharmacotherapies, in order to facilitate the development of future therapies and measures for prevention and control. This article is protected by copyright. All rights reserved


title: Les valeurs usuelles en hématologie vétérinaire

text: The goal of this article is to present the technical aspects and the applications of the blood cells examination and haemostasis in dogs and cats. Technical realisation of blood counts, cytology of normal and abnormal blood cells and significance of the pathologic cell counts are successively treated. Distinctive features of cytology and cell counts in herbivores, horses and cattle, are detailed in a separate chapter. Difficulties of veterinary haematology lie in qualitative and quantitative differences between blood cells of various animal species. Bone marrow cells exploration is not performed in this review.


title: Time from Symptom Onset to Hospitalisation of Coronavirus Disease 2019 (COVID-19) Cases: Implications for the Proportion of Transmissions from Infectors with Few Symptoms

text: Interventions targeting symptomatic hosts and their contacts were successful in bringing the 2003 SARS pandemic under control. In contrast, the COVID-19 pandemic has been harder to contain, partly because of its wide spectrum of symptoms in infectious hosts. Current evidence suggests that individuals can transmit the novel coronavirus while displaying few symptoms. Here, we show that the proportion of infections arising from hosts with few symptoms at the start of an outbreak can, in combination with the basic reproduction number, indicate whether or not interventions targeting symptomatic hosts are likely to be effective. However, as an outbreak continues, the proportion of infections arising from hosts with few symptoms changes in response to control measures. A high proportion of infections from hosts with few symptoms after the initial stages of an outbreak is only problematic if the rate of new infections remains high. Otherwise, it can simply indicate that symptomatic transmissions are being prevented successfully. This should be considered when interpreting estimates of the extent of transmission from hosts with few COVID-19 symptoms.


title: A randomised controlled pilot study to compare filtration factor of a novel non-fit-tested high-efficiency particulate air (HEPA) filtering facemask with a fit-tested N95 mask

text: Summary Use of a fit-tested N95 or FFP2 mask is recommended to protect against transmission of airborne pathogens. This poses considerable logistic problems when preparing for, or dealing with, an epidemic. Some of these problems might be overcome by use of a compact reusable high-efficiency particulate air filtering mask that can be cut to size. We carried out a randomised controlled cross-over study to compare the efficacy of such a mask (Totobobo, Dream Lab One Pte Ltd, Singapore) with fit-tested N95 masks (1860 or 1860s or 1862; 3M, St Paul, MN, USA) in 22 healthy volunteers. The median (interquartile range) reduction in airborne particle counts was significantly higher [193-fold (145–200)] for N95 masks than for Totobobo masks [135-fold (83–184)] (P <0.05). There was no statistically significant difference between the proportion of subjects achieving a reduction of ≥100-fold between N95 (19/22) and Totobobo (16/22) masks. We conclude that use of the Totobobo mask without fit testing cannot be recommended, but its performance is sufficiently promising to warrant further investigation.


title: Clinical characteristics of non-critically ill patients with novel coronavirus infection (COVID-19) in a Fangcang Hospital

text: Abstract Objectives To describe the clinical characteristics of patients in a Fangcang Hospital. Methods Non-critically ill individuals with positive SARS-CoV-2 RT-PCR tests admitted between 7 February and 12 February 2020 to Dongxihu Fangcang Hospital, which was promptly constructed because of the rapid, exponential increase in COVID-19 patients in Wuhan, China, were included; clinical course through to 22 February was recorded. Results A total of 1012 non-critically ill individuals with positive SARS-CoV-2 RT-PCR tests were included in the study. Thirty (of 1012, 3.0%) individuals were asymptomatic on admission. During hospitalization, 16 of 30 (53.3%) asymptomatic individuals developed different symptoms. Fourteen of 1012 patients (1.4%) remained asymptomatic from exposure to the end of follow up, with a median duration of 24 days (interquartile range 22–27). Fever (761 of 1012, 75.2%) and cough (531 of 1012, 52.4%) were the most common symptoms. Small patchy opacities (355 of 917, 38.7%) and ground-glass opacities (508 of 917, 55.4%) were common imaging manifestations in chest CT scans. One hundred patients (9.9%) were transferred to designated hospitals due to aggravation of illness. Diarrhoea emerged in 152 of 1012 patients (15.0%). Male, older age, diabetes, cardiovascular diseases, chills, dyspnoea, So 2 value of ≤93%, white blood cell counts of >10 × 109/L and large consolidated opacities on CT images were all risk factors for aggravation of illness. Conclusions Non-critically ill individuals had different clinical characteristics from critically ill individuals. Asymptomatic infections only accounted for a small proportion of COVID-19. Although with a low incidence, diarrhoea was observed in patients with COVID-19, indicating the possibility of faecal–oral transmission.


title: Comparative community burden and severity of seasonal and pandemic influenza: results of the Flu Watch cohort study

text: BACKGROUND: Assessment of the effect of influenza on populations, including risk of infection, illness if infected, illness severity, and consultation rates, is essential to inform future control and prevention. We aimed to compare the community burden and severity of seasonal and pandemic influenza across different age groups and study years and gain insight into the extent to which traditional surveillance underestimates this burden. METHODS: Using preseason and postseason serology, weekly illness reporting, and RT-PCR identification of influenza from nasal swabs, we tracked the course of seasonal and pandemic influenza over five successive cohorts (England 2006–11; 5448 person-seasons' follow-up). We compared burden and severity of seasonal and pandemic strains. We weighted analyses to the age and regional structure of England to give nationally representative estimates. We compared symptom profiles over the first week of illness for different strains of PCR-confirmed influenza and non-influenza viruses using ordinal logistic regression with symptom severity grade as the outcome variable. FINDINGS: Based on four-fold titre rises in strain-specific serology, on average influenza infected 18% (95% CI 16–22) of unvaccinated people each winter. Of those infected there were 69 respiratory illnesses per 100 person-influenza-seasons compared with 44 per 100 in those not infected with influenza. The age-adjusted attributable rate of illness if infected was 23 illnesses per 100 person-seasons (13–34), suggesting most influenza infections are asymptomatic. 25% (18–35) of all people with serologically confirmed infections had PCR-confirmed disease. 17% (10–26) of people with PCR-confirmed influenza had medically attended illness. These figures did not differ significantly when comparing pandemic with seasonal influenza. Of PCR-confirmed cases, people infected with the 2009 pandemic strain had markedly less severe symptoms than those infected with seasonal H3N2. INTERPRETATION: Seasonal influenza and the 2009 pandemic strain were characterised by similar high rates of mainly asymptomatic infection with most symptomatic cases self-managing without medical consultation. In the community the 2009 pandemic strain caused milder symptoms than seasonal H3N2. FUNDING: Medical Research Council and the Wellcome Trust.


title: Phenotypic heterogeneity of antigen‐specific CD4 T cells under different conditions of antigen persistence and antigen load

text: The factors responsible for the phenotypic heterogeneity of memory CD4 T cells are unclear. In the present study, we have identified a third population of memory CD4 T cells characterized as CD45RA(+)CCR7(–) that, based on its replication history and the homeostatic proliferative capacity, was at an advanced stage of differentiation. Three different phenotypic patterns of memory CD4 T cell responses were delineated under different conditions of antigen (Ag) persistence and load using CD45RA and CCR7 as markers of memory T cells. Mono‐phenotypic CD45RA(–)CCR7(+) or CD45RA(–)CCR7(–) CD4 T cell responses were associated with conditions of Ag clearance (tetanus toxoid‐specific CD4 T cell response) or Ag persistence and high load (chronic HIV‐1 and primary CMV infections), respectively. Multi‐phenotypic CD45RA(–)CCR7(+), CD45RA(–)CCR7(–) and CD45RA(+)CCR7(–) CD4 T cell responses were associated with protracted Ag exposure and low load (chronic CMV, EBV and HSV infections and HIV‐1 infection in long‐term nonprogressors). The mono‐phenotypic CD45RA(–)CCR7(+) response was typical of central memory (T(CM)) IL‐2‐secreting CD4 T cells, the mono‐phenotypic CD45RA(–)CCR7(–) response of effector memory (T(EM)) IFN‐γ‐secreting CD4 T cells and the multi‐phenotypic response of both IL‐2‐ and IFN‐γ‐secreting cells. The present results indicate that the heterogeneity of different Ag‐specific CD4 T cell responses is regulated by Ag exposure and Ag load.


title: Surveillance of enteroviruses from paediatric patients attended at a tertiary hospital in Catalonia from 2014 to 2017

text: Abstract Background Enterovirus (EV) infections are usually asymptomatic or mild, but symptomatic infections can evolve to severe complications. Outbreaks of EV-A71 and EV-D68 have been recently reported worldwide, sometimes related to severe clinical outcomes. Objective To describe EV genetic diversity and the clinical outcomes from paediatric patients attended at a tertiary university hospital in Barcelona (Catalonia, Spain) from 2014 to 2017. Study design Specimens were collected from paediatric (<17 years old) cases with suspicion of respiratory tract infection or EV infection. EV laboratory-confirmation was performed by specific real-time multiplex RT-PCR assay. Partial viral VP1 protein was sequenced for genetic characterisation by phylogenetic analyses. Results A total of 376 (7%) from 5703 cases were EV laboratory-confirmed. Phylogenetic analyses of VP1 (210; 81%) sequences distinguished up to 27 different EV types distributed within EV-A (82; 40%), EV-B (90; 42%), EV-C (5; 2%), and EV-D (33; 15%), in addition to 50 (19%) rhinoviruses. The most predominant were EV-A71 (37; 45%) and EV-D68 (32; 99%). EV-A71 was highly related to neurological complications (25/39, 63%), of which 20/39 were rhombencephalitis, and most EV-D68 (28/32, 88%) were associated with lower respiratory tract infections (LRTI), and exceptionally one (3%) with acute flaccid paralysis. Conclusions EV-A71 and EV-D68 were the most detected EV in respiratory specimens. EV-A71 was highly related to neurological disease and EV-D68 was often associated with LRTI. However, both potential relatedness to neurological diseases makes the monitoring of EV circulation obligatory.


COVID 2019-Suicides: A global psychological pandemic


Spatiotemporal Virus Surveillance for Severe Acute Respiratory Infections in Resource-limited Settings: How Deep Need We Go?


title: The reproductive number of COVID-19 is higher compared to SARS coronavirus

text: Teaser: Our review found the average R0 for 2019-nCoV to be 3.28, which exceeds WHO estimates of 1.4 to 2.5.


Should Respiratory Protection Be Used In All Anorectal Operations That Generate Smoke?


title: Unexpected Cardiac Death During Anaesthesia of a Young Rabbit Associated with Fibro-fatty Replacement of the Right Ventricular Myocardium

text: Summary A 6-month-old female pet rabbit was presented for routine ovariectomy. The pre-anaesthetic evaluation was unremarkable and no anaesthetic complications occurred during the procedure. However, at the end of the surgery, the rabbit suddenly showed acute bradycardia and cardiac death. Necropsy examination revealed marked dilation of the right ventricle, associated with diffuse thinning of the right ventricular free wall. Gross and histopathological findings were suggestive of a congenital dilated cardiomyopathy characterized by fibro-fatty replacement of the right ventricular myocardium. Similar myocardial lesions have not been previously described in rabbits, although they have been documented in myocardial diseases of man, dogs, cats, cattle, horses and chimpanzees.


title: Prevalence and related factors of post-traumatic stress disorder among medical staff members exposed to H7N9 patients

text: OBJECTIVE: This study aimed to evaluate the prevalence and related factors of post-traumatic stress disorder (PTSD) symptoms among doctors and nurses who were exposed to H7N9 patients during the H7N9 influenza epidemic. To provide scientific basis for promoting the physical and psychological health of these staff members. METHOD: The 102 medical staff workers who were exposed to H7N9 patients were recruited through convenient sampling between January 2015 and May 2016. We used a self-reported questionnaire, the PTSD Checklist-Civilian Version (PCL-C), to evaluate the PTSD symptoms among doctors and nurses from an intensive care unit (n = 61), a respiratory department (n = 20), and an emergency department (n = 21). We then analyzed the related factors. RESULTS: Around 20.59% of the tested doctors and nurses showed PTSD symptoms. The sample had a mean PCL-C score of 30.00 ± 9.95. The differences in the scores of doctors and nurses with different genders, ages, professional titles, contact frequencies, trainings, and experiences were statistically significant (P < 0.05, P < 0.01). Moreover, t-tests and one-way analysis of variance showed that nurses received higher scores than doctors, female participants received higher scores than male participants, and the participants with low professional title and high contact frequency, aged between 20 years and 30 years, with less than five years of work experience, having not received related training and with no related experience obtained higher PCL-C scores than the others (P < 0.05, P < 0.01). CONCLUSION: The PTSD level of doctors and nurses after their exposure to H7N9 patients was high, which warrant further research. Health and medical institutions should pay attention to the physical and psychological health of these staff members.


Number of cases across Africa remains low


docid: uylvtqlu

title: First case of acute pancreatitis related to SARS‐CoV‐2 infection


title: Drivers of MERS-CoV Emergence in Qatar

text: MERS-CoV (Middle East respiratory syndrome corona virus) antibodies were detected in camels since 1983, but the first human case was only detected in 2012. This study sought to identify and quantify possible drivers for the MERS-CoV emergence and spillover to humans. A list of potential human, animal and environmental drivers for disease emergence were identified from literature. Trends in possible drivers were analyzed from national and international databases, and through structured interviews with experts in Qatar. The discovery and exploitation of oil and gas led to a 5-fold increase in Qatar GDP coupled with a 7-fold population growth in the past 30 years. The lifestyle gradually transformed from Bedouin life to urban sedentary life, along with a sharp increase in obesity and other comorbidities. Owing to substantial governmental support, camel husbandry and competitions flourished, exacerbating the already rapidly occurring desertification that forced banning of free grazing in 2005. Consequently, camels were housed in compact barns alongside their workers. The transition in husbandry leading to high density camel farming along with increased exposure to humans, combined with the increase of camel movement for the racing and breeding industry, have led to a convergence of factors driving spillover of MERS-CoV from camels to humans.


title: Neuropathogenesis of a highly pathogenic avian influenza virus (H7N1) in experimentally infected chickens

text: In order to understand the mechanism of neuroinvasion of a highly pathogenic avian influenza virus (HPAIV) into the central nervous system (CNS) of chickens, specific pathogen free chickens were inoculated with a H7N1 HPAIV. Blood, cerebrospinal fluid (CSF), nasal cavity and brain tissue samples were obtained from 1 to 4 days post-inoculation (dpi) of infected and control chickens. Viral antigen topographical distribution, presence of influenza A virus receptors in the brain, as well as, the role of the olfactory route in virus CNS invasion were studied using different immunohistochemistry techniques. Besides, viral RNA load in CSF and blood was quantified by means of a quantitative real-time reverse transcription-polymerase chain reaction. Viral antigen was observed widely distributed in the CNS, showing bilateral and symmetrical distribution in the nuclei of the diencephalon, mesencephalon and rhombencephalon. Viral RNA was detected in blood and CSF at one dpi, indicating that the virus crosses the blood-CSF-barrier early during infection. This early dissemination is possibly favoured by the presence of Siaα2,3 Gal and Siaα2,6 Gal receptors in brain vascular endothelial cells, and Siaα2,3 Gal receptors in ependymal and choroid plexus cells. No viral antigen was observed in olfactory sensory neurons, while the olfactory bulb showed only weak staining, suggesting that the virus did not use this pathway to enter into the brain. The sequence of virus appearance and the topographical distribution of this H7N1 HPAIV indicate that the viral entry occurs via the haematogenous route, with early and generalized spreading through the CSF.


Epidemics will always come (and go): the need to prepare for the next one, research on COVID-19, and the role of molecular and cellular endocrinology


title: Ventilator-Associated Pneumonia New Definitions

text: The National Healthcare Safety Network’s new classification characterizes all adverse ventilator-associated events (VAE) into a tiered system designed to shift the focus away from ventilator-associated pneumonia as the only important cause or morbidity in ventilated patients. This new surveillance definition of VAE eliminates subjectivity by using clearly defined criteria and facilitates the automated collection of data. This allows for easier comparison and analysis of factors affecting rates of VAE. Numerous studies have been published that demonstrate its clinical application. This article presents the VAE criteria, contrasts the difference from the previous ventilator-associated pneumonia definition, and discusses its implementation over the past 5 years.


title: O-glycosylation of intact and truncated ribophorins in brefeldin A- treated cells: newly synthesized intact ribophorins are only transiently accessible to the relocated glycosyltransferases

text: Ribophorins I and II are type I transmembrane glycoproteins of the ER that are segregated to the rough domains of this organelle. Both ribophorins appear to be part of the translocation apparatus for nascent polypeptides that is associated with membrane-bound ribosomes and participate in the formation of a proteinaceous network within the ER membrane that also includes other components of the translocation apparatus. The ribophorins are both highly stable proteins that lack O- linked sugars but each contains one high mannose N-linked oligosaccharide that remains endo H sensitive throughout their lifetimes. We have previously shown (Tsao, Y. S., N. E. Ivessa, M. Adesnik, D. D. Sabatini, and G. Kreibich. 1992. J. Cell Biol. 116:57- 67) that a COOH-terminally truncated variant of ribophorin I that contains only the first 332 amino acids of the luminal domain (RI332), when synthesized in permanent transformants of HeLa cells, undergoes a rapid degradation with biphasic kinetics in the ER itself and in a second, as yet unidentified nonlysosomal pre-Golgi compartment. We now show that in cells treated with brefeldin A (BFA) RI332 molecules undergo rapid O-glycosylation in a multistep process that involves the sequential addition of N-acetylgalactosamine, galactose, and terminal sialic acid residues. Addition of O-linked sugars affected all newly synthesized RI332 molecules and was completed soon after synthesis with a half time of about 10 min. In the same cells, intact ribophorins I and II also underwent O-linked glycosylation in the presence of BFA, but these molecules were modified only during a short time period immediately after their synthesis was completed, and the modification affected only a fraction of the newly synthesized polypeptides. More important, these molecules synthesized before the addition of BFA were not modified by O-glycosylation. The same is true for ribophorin I when overexpressed in HeLa cells although it is significantly less stable than the native polypeptide in control cells. We, therefore, conclude that soon after their synthesis, ribophorins lose their susceptibility to the relocated Golgi enzymes that effect the O-glycosylation, most likely as a consequence of a conformational change in the ribophorins that occurs during their maturation, although it cannot be excluded that rapid integration of these molecules into a supramolecular complex in the ER membrane leads to their inaccessibility to these enzymes.


title: Measles transmission during a large outbreak in California

text: A large measles outbreak in 2014–2015, linked to Disneyland theme parks, attracted international attention, and led to changes in California vaccine policy. We use dates of symptom onset and known epidemic links for California cases in this outbreak to estimate time-varying transmission in the outbreak, and to estimate generation membership of cases probabilistically. We find that transmission declined significantly during the course of the outbreak (p = 0.012), despite also finding that estimates of transmission rate by day or by generation can overestimate temporal decline. We additionally find that the outbreak size and duration alone are sufficient in this case to distinguish temporal decline from time-invariant transmission (p = 0.014). As use of a single large outbreak can lead to underestimates of immunity, however, we urge caution in interpretation of quantities estimated from this outbreak alone. Further research is needed to distinguish causes of temporal decline in transmission rates.


docid: qjnmcaky

title: Dietary restriction of amino acids for Cancer therapy

text: Biosyntheses of proteins, nucleotides and fatty acids, are essential for the malignant proliferation and survival of cancer cells. Cumulating research findings show that amino acid restrictions are potential strategies for cancer interventions. Meanwhile, dietary strategies are popular among cancer patients. However, there is still lacking solid rationale to clarify what is the best strategy, why and how it is. Here, integrated analyses and comprehensive summaries for the abundances, signalling and functions of amino acids in proteomes, metabolism, immunity and food compositions, suggest that, intermittent dietary lysine restriction with normal maize as an intermittent staple food for days or weeks, might have the value and potential for cancer prevention or therapy. Moreover, dietary supplements were also discussed for cancer cachexia including dietary immunomodulatory.


title: Placing Resources: Junior Mining Companies and the Locus of Mineral Potential

text: Ideas of resource becoming have become prominent across scholarship on resource geography over the past two decades. In this article, I link processes of becoming with those of place. Drawing on research focused on copper exploration and the junior mining sector, I describe the way resource potential is articulated through three distinct practices of placing: the placing of resource prospects within narratives of copper deficits; the placing of resource prospects in space; and the placing of resource prospects in juxtaposition to other projects. These promotional taken-for-granted practices within the junior mining industry not only underscore the way resource potential is tied to spatial and temporal narratives, but illustrate that the locus of resource potential is found in areas beyond the underground.


title: Efficient GAN-based Chest Radiographs (CXR) augmentation to diagnose coronavirus disease pneumonia

text: Background: As 2019 ends coronavirus disease start expanding all over the world. It is highly transmissible disease that can affect respiratory tract and can leads to organ failure. In 2020 it is declared by world health organization as “Public health emergency of international concerns”. The current situation of Covid-19 and chest related diseases have already gone through radical change with the advancements of image processing tools. There is no effective method which can accurately identify all chest related diseases and tackle the multiple class problems with reliable results. Method: There are many potentially impactful applications of Deep Learning to fighting the Covid-19 from Chest X-Ray/CT Images, however, most are still in their early stages due to lack of data sharing as it continues to inhibit overall progress in a variety of medical research problems. Based on COVID-19 radiographical changes in CT images, this work aims to detect the possibility of COVID-19 in the patient. This work provides a significant contribution in terms of Gan based synthetic data and four different types of deep learning- based models which provided state of the art comparable results. Results: A Deep Neural Network model provides a significant contribution in terms of detecting COVID-19 and provides effective analysis of chest related diseases with respect to age and gender. Our model achieves 89% accuracy in terms of Gan based synthetic data and four different types of deep learning- based models which provided state of the art comparable results. Conclusion: If the gap in identifying of all viral pneumonias is not filled with effective automation of chest disease detection the healthcare industry may have to bear unfavorable circumstances.


title: Rapid Manufacturable Ventilator for Respiratory Emergencies of COVID-19 Disease

text: Influenza like pandemics are a severe threat to any established health care system as many thousands of patients would need emergency ventilator support during the acute respiratory failure stage, and this quickly overloads the existing facilities. The present article addresses the design and development of a human breathing assist machine (ventilator) prototype for use by qualified medical professionals in the emergency room, as well as in other locations, where a regular ventilator machine cannot be made available. The ventilator has been designed using readily available locally sourced materials, which can be assembled in a short time. This ensures the minimum required features to ventilate a patient in emergency conditions. The popular crank-rocker mechanism has been used to meet some of the vital design requirements of the emergency ventilator. The size of the links has been chosen to maintain a fixed inspiratory-to-expiratory (I:E) time ratio of 1:2. The kinematic linkage design has been kept modular by introducing a feature to adjust the location of the rocker tip to control the tidal volume from 100 ml to 600 ml of oxygenated air per breath. A virtual CAD model, based on the above-mentioned linkage design, has been designed to assess the variation of the position and velocity with time. Finally, a working prototype has been made, and it was observed that the I:E time ratio of 1:2 was achieved satisfactorily.


docid: fxtzitpk

title: Structures of MERS-CoV spike glycoprotein in complex with sialoside attachment receptors

text: The Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe and often lethal respiratory illness in humans, and no vaccines or specific treatments are available. Infections are initiated via binding of the MERS-CoV spike (S) glycoprotein to sialosides and dipeptidyl-peptidase 4 (the attachment and entry receptors, respectively). To understand MERS-CoV engagement of sialylated receptors, we determined the cryo-EM structures of S in complex with 5-N-acetyl neuraminic acid, 5-N-glycolyl neuraminic acid, sialyl-Lewis(X), α2,3-sialyl-N-acetyl-lactosamine and α2,6-sialyl-N-acetyl-lactosamine at 2.7–3.0 Å resolution. We show that recognition occurs via a conserved groove that is essential for MERS-CoV S-mediated attachment to sialosides and entry into human airway epithelial cells. Our data illuminate MERS-CoV S sialoside specificity and suggest that selectivity for α2,3-linked over α2,6-linked receptors results from enhanced interactions with the former class of oligosaccharides. This study provides a structural framework explaining MERS-CoV attachment to sialoside receptors and identifies a site of potential vulnerability to inhibitors of viral entry.


title: Can the Elastic of Surgical Face Masks Stimulate Ear Protrusion in Children?

text: In this period of the Covid-19 pandemic, a protective mask has become a common object of use to contain virus transmission. The imminent need for masks has led many governments to produce them, including surgical masks with elastic loops or masks with side cuts at the ears. Among those on the market, surgical masks with elastic loops are the ones most chosen by parents for their children. These elastics cause constant compression on the skin and, consequently, on the cartilage of the auricle, leading to erythematous and painful lesions of the retroauricular skin when the masks are used for many hours a day. Pre-adolescent children have undeveloped auricular cartilage with less resistance to deformation; prolonged pressure from the elastic loops of the mask at the hollow or, even worse, at the anthelix level can influence the correct growth and angulation of the outer ear. In fact, unlike when using conservative methods for the treatment of protruding ears, this prolonged pressure can increase the cephaloauricular angle of the outer auricle. It is important for the authorities supplying the masks to be aware of this potential risk and for alternative solutions to be found while maintaining the possibility of legitimate prevention of the potential spread of the virus. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266.


title: Lions, Tigers and Kittens too: ACE2 and susceptibility to CoVID-19

text: SARS-CoV-2 (Severe Acute Respiratory Syndrome coronavirus 2) has been reported to infect domesticated animals in a species-specific manner, where cats were susceptible but not dogs. Using the recently published crystal structure of the SARS-CoV-2 spike protein complexed with the human host cell receptor ACE2, we characterized the structure and evolution of ACE2 in several of these species and identify a single interacting amino acid residue conserved between human and Felidae ACE2 but not in Canidae that correlates with virus susceptibility. Using computational analyses we describe how this site likely affects ACE2 targeting by the virus. Thus, we highlight how evolution-based approaches can be used to form hypotheses and study animal transmission of such viruses in the future. Lay summary: Recently, the virus that causes COVID-19 was shown to transmit to companion animals. A single genetic change in the host receptor for the virus inherited in cats, but not dogs, correlates with feline susceptibility. With human-to-cat transmission of COVID-19 confirmed, such information can inform public health policy regarding companion animals.


Echocardiographic Findings in COVID-19 Patients with Significant Myocardial Injury


title: Biological and antigenic relationships between virus-induced porcine and human interferons

text: Summary Endogenous interferon (IFN) made by the newborn piglet in response to enteric coronavirus TGEV (transmissible gastroenteritis virus) infection was identified as leukocytic IFN (IFN-α). Indeed, the antiviral activity found in the serum and in the urine of infected piglets displayed the same main biological and antigenic properties as the IFN induced in influenza-infected pig leukocytes. It is therefore concluded that most, if not all, circulating IFN activity must be derived from lymphoid cells. Moreover, it was shown that a high degree of antigenic homology exists between porcine and human IFN-α: antibodies to HuIFN-α could efficiently neutralize PorIFN-α, and they were used for its purification by immunoaffinity.


title: Importance of colostrum IgG antibodies level for prevention of infection with Cryptosporidium parvum in neonatal dairy calves

text: Abstract Cryptosporidiosis is one of the most common zoonosis worldwide, causing intestinal infection to both humans and livestock. The purpose of this study was to assess whether the level of anti-C. parvum IgG antibodies transferred through colostrum from dams to newborn calves impacts the susceptibility to cryptosporidiosis. A number of 50 dams and their healthy newborns were included in the study. Colostrum samples were collected within 12 h after birth and anti-C. parvum IgG antibody levels were determined by single radial immunodiffusion. The health condition of the newborns was daily monitored, and fecal samples were collected at first diarrheic episode of a calf. In all dams, the anti-C. parvum IgG antibody concentration in colostrum varied between 570 and 4070 mg/dl; in dams who gave birth to calves with diarrhea and were C. parvum-positive, the antibody concentration in colostrum varied between 680 and 3680 mg/dl (Table 1). The point-biserial correlation showed a negative correlation between the levels of anti-C. parvum antibodies and manifestation of clinical cryptosporidiosis (r=-0.425). Our findings highlight the importance of IgG levels in colostrum received by neonatal calves during their first day of life for prevention of C. parvum infection.


title: Hopelessness, helplessness and resilience: The importance of safeguarding our trainees' mental wellbeing during the COVID-19 pandemic

text: • The COVID-19 pandemic may put the mental wellbeing of trainees at risk. • Hopelessness, helplessness and burnout are important to be aware of. • We need to foster an open culture of trust and support. • We need to promote resilience in colleagues/trainees where possible.


title: Changes in the prescription pattern of antipsychotics for schizophrenic outpatients after the implementation of a global budgeting program

text: Abstract Background A hospital-based global budget (GB) program was implemented by the Taiwan Bureau of National Health Insurance (TBNHI) to control the rising costs of medical care. We investigated whether the introduction of the GB program affected prescriptions for second-generation antipsychotics (SGAs) for schizophrenic outpatients in public and private medical and psychiatric centers. Methods The prescription data of schizophrenic outpatients treated between 2001 and 2004 were retrieved from the TBNHI database, which included outpatients who were diagnosed as having schizophrenia during the period from 1996 to 2001. Because the new health insurance policy may have had a lag effect on physicians' decision regarding SGA prescription, we used January 2004 as the timepoint to divide the data, which was 6 months after GB implementation. Thus, data from the 6-month period immediately after the GB implementation were included in the pre-GB period. Second-generation antipsychotics included in the study were clozapine, risperidone, olanzapine, quetiapine, ziprasidone, zotepin, and amisulpride. Results After January 2004, the proportion of SGA use in outpatient departments did not show an upward trend, as had been observed in the pre-GB period, which appeared at a staggering pace lasting for 12 months (p = 0.0004). Compared with medical centers, SGA expenditures in the psychiatric centers were less affected in the GB period (p < 0.0001). Compared to the private sector, the SGA expenditures in the public sector were less affected in the GB period (p < 0.019). Conclusion We concluded that the GB implementation reduced SGA expenditures significantly. The extent of influence varied among hospitals (i.e., public versus private, medical versus psychiatric centers), which was most likely caused by financial factors.


title: Modulation of Hb-O(2) affinity to improve hypoxemia in COVID-19 patients

text: This opinion paper aims at discussing the potential impact of modulating the Hb-O(2) affinity by the nutritional supplement 5-HMF on patients affected by COVID-19. The paper describes the critical role of the oxygen affinity in hypoxemic COVID-19 patients and the potential positive effect of 5-HMF, a compound shown to increase the Hb-O(2) affinity.


Implementation of the Integrated Care of Older People (ICOPE) App in Primary Care: New Technologies in Geriatric Care During Quarantine of COVID-19 and Beyond


title: An alternative pathway of enteric PEDV dissemination from nasal cavity to intestinal mucosa in swine

text: Porcine epidemic diarrhea virus (PEDV) has catastrophic impacts on the global pig industry. Although the fecal–oral route is generally accepted, an increased number of reports indicate that airborne transmission may contribute to PEDV outbreak. Here, we show that PEDV could cause typical diarrhea in piglets through a nasal spray. Firstly, PEDV can develop a transient nasal epithelium infection. Subsequently, PEDV-carrying dendritic cells (DCs) allow the virus to be transferred to CD3(+) T cells via the virological synapse. Finally, virus-loaded CD3(+) T cells reach the intestine through the blood circulation, leading to intestinal infection via cell-to-cell contact. Our study provides evidence for airborne transmission of a gastrointestinal infected coronavirus and illustrates the mechanism of its transport from the entry site to the pathogenic site.


Ménage à trois of bacterial and viral pulmonary pathogens delivers coup de grace to the lung


title: Managing uncertainty during a global pandemic: An international business perspective

text: Despite the perennial need to understand and manage uncertainty in international business, there is no comprehensive framework that incorporates different types of uncertainty, their antecedents and outcomes, and the different coping strategies used by managers and their outcomes. This makes it difficult for international business managers to understand the types of uncertainty in their businesses and develop appropriate strategies to deal with it effectively, especially during times such as the ongoing Covid-19 pandemic. This paper uses an extensive review of the international business literature to address the above research gap by identifying the different types of uncertainty, their antecedents and outcomes, the coping strategies used to mitigate their impact, and the consequences of these actions. The authors also use examples from the current Covid-19 crisis to assess the firms’ responses and their consequences. The paper concludes with some implications for international business managers and directions for future research.


The Parallel Pandemic: Medical Misinformation and COVID-19: Primum non nocere


title: Ethnopharmacology, phytochemistry, biological activities, and therapeutic applications of Cedrela serrata Royle: A mini review

text: Abstract Ethnopharmacological relevance Cedrela serrata Royle (C. serrata) is a medicinal plant not only used for constructions but also an important conventional medicine for the treatment of various diseases such as; diabetes, jaundice, liver diseases, diarrhea, fever, chronic infantile dysentery, intestinal worms, hypertension, skin and blood diseases. Aims This review article documents and critically assesses, for the first time; up to date categorized information about C. serrata including its reported pharmacological activities, cultural uses, active compounds, and botanical description. Materials and method s: All provided information about C. serrata was collected using the electronic databases (e.g. Google Scholar, Web of Science, Scopus, PubMed, Science Direct and Springer Link), books (e.g. Trees of Pakistan and Herbalism, Phytochemistry, and Ethnopharmacology) and thesis. Results Qualitative and quantitative phytochemical studies on C. serrata revealed the presence of important chemical constituents such as; flavonoids, phenolic acids, alkaloids, saponins, tannins, and cardiac glycosides. The phytochemicals showed various in vitro activities like antioxidant, anti-infective, antiglycation, cytotoxic activities. Major areas of research conducted on C. serrata are its antioxidant and anti-infective activities. Few historical uses of C. serrata are supported by modern in vitro pharmacological studies such as; antidiarrheal, antidiabetic, and leishmanicidal activity. Conclusion There were convincing evidence in in vitro studies supporting C. serrata antioxidant, anti-infective, anti-diabetic, anti-glycating, and cytotoxic activities. Nevertheless, all reported pharmacological activities were carried out in vitro and a gap in research i.e. preclinical and clinical investigation still exists. The authors emphasize the need for future in-depth research and clinical trials to investigate C. serrata pharmacological activity, clinical efficacy and safety. The potential chemical compounds with suggestive classes may need to be isolated and pharmacological activities must be established for these compounds. The plant has very limited information about pharmacological activities and the data available for supportive cultural uses needs proper validation.


title: Effects of the COVID-19 Pandemic on the Management of Patients With ST-elevation Myocardial Infarction in a Tertiary Cardiovascular Center

text: In the Coronavirus Disease 2019 (COVID-19) pandemic, the appropriate reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI) is unclear. METHODS: This retrospective single-center study consecutively enrolled patients who presented with STEMI and scheduled for primary percutaneous coronary intervention (PPCI) during the outbreak of COVID-19. Due to the delay in the reporting of the polymerase chain reaction test results, our postprocedural triage regarding COVID-19, followed by the isolation strategy, was based on lung computerized tomography scan results. RESULTS: Forty-eight patients with STEMI referred to our center. PPCI was done for 44 (91%) of these patients. The mean symptom-to-device time was 490.93 ± 454.608 minutes, and the mean FMC-to-device time was and 154.12 ± 36.27 minutes. Nine (18%) patients with STEMI were diagnosed as having typical/indeterminate features indicating COVID-19 involvement. During hospitalization, 1 (2.0%) patient died of cardiogenic shock. The study population was followed for 35.9 ± 12.7 days. Two patients expired in another centers due to COVID-19. No cardiac catheterization laboratory staff members were infected by COVID-19 during the study period. CONCLUSIONS: Our small report indicates that by taking the recommended safety measures and using appropriate PPE, we can continue PPCI as the main reperfusion strategy safely and effectively.


title: Asymptomatic cases with SARS‐CoV‐2 infection

text: On 31 March 2020, Chinese Health Authorization announced that numbers of asymptomatic cases with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection will be made to the public daily. This was a very important step since different counties have different capacities for the detection of SARS‐CoV‐2 infection and control strategy for the Coronavirus Disease 2019 outbreak. We summarized the characteristics of asymptomatic SARS‐CoV‐2 infections and the transmission potential of asymptomatic cases. Then we provided guidelines for the management of asymptomatic cases through quarantine and nucleic acid/serology tests.


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title: Reverse genetics approaches to combat pathogenic arenaviruses

text: Several arenaviruses cause hemorrhagic fever (HF) in humans, and evidence indicates that the worldwide-distributed prototypic arenavirus lymphocytic choriomeningitis virus (LCMV) is a neglected human pathogen of clinical significance. Moreover, arenaviruses pose a biodefense threat. No licensed anti-arenavirus vaccines are available, and current anti-arenavirus therapy is limited to the use of ribavirin, which is only partially effective and is associated with anemia and other side effects. Therefore, it is important to develop effective vaccines and better antiviral drugs to combat the dual threats of naturally occurring and intentionally introduced arenavirus infections. The development of arenavirus reverse genetic systems is allowing investigators to conduct a detailed molecular characterization of the viral cis-acting signals and trans-acting factors that control each of the steps of the arenavirus life cycle, including RNA synthesis, packaging and budding. Knowledge derived from these studies is uncovering potential novel targets for therapeutic intervention, as well as facilitating the establishment of assays to identify and characterize candidate antiviral drugs capable of interfering with specific steps of the virus life cycle. Likewise, the ability to generate predetermined specific mutations within the arenavirus genome and analyze their phenotypic expression would significantly contribute to the elucidation of arenavirus-host interactions, including the basis of their ability to cause severe HF. This, in turn, could lead to the development of novel, potent and safe arenavirus vaccines.


title: O-linked oligosaccharides are acquired by herpes simplex virus glycoproteins in the Golgi apparatus

text: Abstract The O-linked oligosaccharides on mature forms of herpes simplex virus type 1 (HSV1) glycoproteins were characterized, and were found to account largely for the lower electrophoretic mobilities of these forms relative to the mobilities of immature forms. Other posttranslational modifications of HSV1 glycoproteins (designated gB, gC, gD and gE) were related temporally to the discrete shifts in electrophoretic mobilities that signal acquisition of the O-linked oligosaccharides. Fatty acid acylation (principally of gE) could be detected just prior to the shifts, whereas conversion of high-mannosetype N-linked oligosaccharides to the complex type occurred coincident with the shifts. The addition of O-linked oligosaccharides did not occur in cells treated with the ionophore monensin or in a ricinresistant cell line defective in the processing of N-linked oligosaccharides. We conclude that extension of O-linked oligosaccharide chains on HSV1 glycoproteins, and probably also attachment of the first O-linked sugars, occurs as a late posttranslational modification in the Golgi apparatus.