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OBJECTIVE: This article investigates how perceived vulnerability to the COVID-19 pandemic at its early stages is associated with people's perception of their health, the need for healthcare services, and expenses related to addressing the COVID-19 impact on their health. METHODS: The results are based on the analysis of surveys that were distributed among members of 26 random Facebook groups in April-May, 2020. Perceived COVID-19 pandemic related stress and health concerns were examined by using the ANOVA test. RESULTS: Among 315 respondents, 64% have experienced COVID-19 related stress and identified anxiety, headache, insomnia, and weight gain as their primary health concerns. The ANOVA test revealed that females are more impacted by the COVID-19 stress than males. Around 40% of respondents believed that the COVID-19 would lead to an increase in the cost of health services, and 20% of respondents anticipated that the COVID-19 pandemic would increase their need for health services. CONCLUSIONS: Learning about how people perceive the COVID-19 pandemic impact on their health, particularly in the pandemic's early stages can allow health professionals to develop targeted interventions that can influence pandemic preventative behaviors among different population groups. This study can help understand utilization patterns and mitigate financial barriers that could interfere with patients' care-seeking behavior.

Effect of the COVID-19 on perceptions of health, anticipated need for health services, and cost of healthcare

OBJECTIVES: Vaccinations work with different mechanisms to offer protection against disease; however, process of immunity building can cause symptoms. Therefore, this study aimed to determine the immediate side effects of COVID–19 vaccination in the Pakistani Population. METHODS: This cross-sectional analytical study was conducted at Foundation University College of Dentistry, Islamabad from February to April 2021. 0.5 mL per dose of the Covid-19 vaccine was administered to the candidates. These 205 candidates receiving vaccination were then interviewed investigating the adverse effects of the vaccine. Post-vaccination side effects were compared among categorical groups using the Chi-Square test, whereas post-vaccination side effects were compared with age using independent samples T-test. A p-value of ≤0.05 was statistically significant. RESULTS: Among post-vaccination side effects, fever was reported by 69 participants, while 56 of 205 reported soreness, redness, and swelling at the injection site. It was reported by 42/205 participants to have felt chills and rigor, whereas gastrointestinal disturbance and flu-like symptoms were reported in 55/205 and 28/205 participants, respectively. Younger participants were more likely to develop gastrointestinal disturbance and flu-like symptoms following vaccination as compared to older participants. CONCLUSION: Malaise, headache, and fever were observed to be the most common side effects of the vaccine, moreover there was a linear relationship between manifestations of adverse effects and history of comorbidities.

Evaluation of adverse effects with COVID-19 vaccination in Pakistan

COVID-19 is a global public health emergency with more than one million positive cases across the globe. COVID-19 has a multifaceted presentation. We are herein to report two cases of SARS-CoV-2 induced rhabdomyolysis with an initial presentation of weakness and elevated creatinine kinase (CK). Both patients had no respiratory symptoms, they only complained of generalized weakness and were found to have elevated CK. Routine chest X-ray showed bilateral infiltrates in both cases and subsequently reverse-transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 was positive. To the best of our knowledge, there was only one literature to date documented SARS-CoV-2 induced rhabdomyolysis as a late complication of COVID-19 patient. Our cases showed that elevated CK and rhabdomyolysis can be the sole initial presentation of patients with COVID-19 and total CK should be ordered in every patient on admission.

Weakness and elevated creatinine kinase as the initial presentation of coronavirus disease 2019 (COVID-19)

OBJECTIVE: To describe disease-modifying antirheumatic drug (DMARD) disruption, rheumatic disease flare/activity, and prolonged COVID-19 symptom duration among COVID-19 survivors with systemic autoimmune rheumatic diseases (SARDs). METHODS: We surveyed patients with SARDs after confirmed COVID-19 at Mass General Brigham to investigate post-acute sequelae of COVID-19. We obtained data on demographics, clinical characteristics, COVID-19 symptoms/course, and patient-reported measures. We examined baseline predictors of prolonged COVID-19 symptom duration (defined as lasting ≥28 days) using logistic regression. RESULTS: We analyzed surveys from 174 COVID-19 survivors (mean age 52 years, 81% female, 80% White, 50% rheumatoid arthritis) between March 2021 and January 2022. Fifty-one percent of 127 respondents on any DMARD reported a disruption to their regimen after COVID-19 onset. For individual DMARDs, 56-77% had any change, except for hydroxychloroquine (23%) and rituximab (46%). SARD flare after COVID-19 was reported by 41%. Global patient-reported disease activity was worse at the time of survey than before COVID-19 (mean 6.6±2.9 vs. 7.6±2.3, p<0.001). Median time to COVID-19 symptom resolution was 14 days (IQR 9,29). Prolonged symptom duration of ≥28 days occurred in 45%. Hospitalization for COVID-19 (OR 3.54, 95%CI 1.27-9.87) and initial COVID-19 symptom count (OR 1.38 per symptom, 95%CI 1.17-1.63) were associated with prolonged symptom duration. Respondents experiencing prolonged symptom duration had higher RAPID3 scores (p=0.007) and more pain (p<0.001) and fatigue (p=0.03) compared to those without prolonged symptoms. CONCLUSION: DMARD disruption, SARD flare, and prolonged symptom duration were common in this prospective study of COVID-19 survivors, suggesting substantial impact on SARDs after acute COVID-19.

DMARD disruption, disease flare, and prolonged symptom duration after acute COVID-19 among participants with rheumatic disease: A prospective study

Since this COVID-19 pandemic thrives, the utilization of X-Ray images of the Chest (CXR) as a complementary screening technique to RT-PCR testing grows to its clinical use for respiratory complaints. Many new deep learning approaches have developed as a consequence. The goal of this research is to assess the convolutional neural networks (CNNs) to diagnosis COVID-19 utisizing X-ray images of chest. The performance of CNN with one, three, and four convolution layers has been evaluated in this research. A dataset of 13,808 CXR photographs are used in this research. When evaluated on X-ray images with three splits of the dataset, our preliminary experimental results show that the CNN model with three convolution layers can reliably detect with 96 percent accuracy (precision being 96 percent). This fact indicates the commitment of our suggested model for reliable screening of COVID-19.

Recognition of COVID-19 Disease Utilizing X-Ray Imaging of the Chest Using CNN

The kinetics of NKG2C+ adaptive natural killer (ANK) cells and NKG2A+inhibitory NK (iNK) cells with respect to the incidence of SARS-CoV-2 infection were studied in a cohort of health-care workers following administration of heat killed Mycobacterium w (Mw group) in comparison to a control group. COVID-19 infection correlated with a lower NKG2C+ANK cells at baseline. NKG2C+ANK cells at baseline did not differ, but there was a significant upregulation of NKG2C expression and cytokine release in the Mw group (p=0.0009), particularly in those with lower baseline NKG2C expression (<15%), along with marked downregulation of NKG2A+iNK cells (p<0.0001), and an increase in the NKG2C+ANK/NKG2A+iNK ratio. This translated to a significant reduction in COVID-19 and its severity in the Mw group. No impact was observed on T cell subsets. Mw was observed to have a salutary impact on the ANK cell profile which might have provided protection against COVID-19 over a prolonged period in a non-immune high-risk population.

Impact Of an Immune Modulator Mycobacterium-w On Adaptive Natural Killer Cells and Protection Against COVID-19

In consideration of the increasing prevalence of COVID-19 cases in several countries and the resulting demand for unbiased sequencing approaches, we performed a direct RNA sequencing (direct RNA seq.) experiment using critical oropharyngeal swab samples collected from Italian patients infected with SARS-CoV-2 from the Palermo region in Sicily. Here, we identified the sequences SARS-CoV-2 directly in RNA extracted from critical samples using the Oxford Nanopore MinION technology without prior cDNA retrotranscription. Using an appropriate bioinformatics pipeline, we could identify mutations in the nucleocapsid (N) gene, which have been reported previously in studies conducted in other countries. In conclusion, to the best of our knowledge, the technique used in this study has not been used for SARS-CoV-2 detection previously owing to the difficulties in the extraction of RNA of sufficient quantity and quality from routine oropharyngeal swabs. Despite these limitations, this approach provides the advantages of true native RNA sequencing and does not include amplification steps that could introduce systematic errors. This study can provide novel information relevant to the current strategies adopted in SARS-CoV-2 next-generation sequencing.

Direct RNA Nanopore Sequencing of SARS-CoV-2 Extracted from Critical Material from Swabs

STUDY OBJECTIVE: The potential of infectious disease spread in diseases such as tuberculosis, infectious disease epidemic such as avian flu and the threat of terrorism with agents capable of airborne transmission have focused attention on the need for increased surge capacity for patient isolation. Total negative pressure isolation using portable bioisolation tents may provide a solution. The study assesses the ability of health care workers to perform emergency procedures in this environment. METHODS: Physician performance in completing predetermined critical actions in 5 emergency care scenarios inside and outside of a bioisolation tent (“setting”) was studied in an advanced medical simulation laboratory. By design, no pretraining of subjects about total negative pressure isolation use occurred. Impact of setting on time to completion of predetermined critical actions was the primary outcome measured. Secondary variables studied included impact of study groups, scenarios, and run order (inside or outside of the tent first). Subjective assessments were obtained through questionnaires. RESULTS: Four teams of 3 physicians completed 5 emergency patient care scenarios during 2 4-hour sessions. Mean time to completion of critical actions was for tent/no tent 298 seconds/284 seconds (P=.69, one way ANOVA), respectively. Mean time to completion for first versus second performance of a scenario in the crossover design was 338 versus 243 (P=.01). The mean score for self-assessed performance did not differ according to setting. CONCLUSION: The ability of physicians naive to the total negative pressure isolation environment to perform emergency medical critical actions was not significantly degraded by a simulated bioisolation tent patient care environment.

Initial Test of Emergency Procedure Performance in Temporary Negative Pressure Isolation by Using Simulation Technologies

Self-management support is one of the most important components of the Chronic Care Model (CCM). The EMPOWER-SUSTAIN Global Cardiovascular Risks Self-Management Booklet(©) was developed for patients with Metabolic Syndrome (MetS), inspired by the CCM. Assessing usability of a self-management tool is important in chronic disease management. However, there was no available instrument to assess usability of a self-management booklet, as most instruments were developed to assess usability of mobile application. Therefore, this study aimed to adapt Skala Kebolehgunaan Aplikasi Mudah Alih (SKAMA) into the EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) and to determine its validity and reliability in assessing usability of a self-management booklet. A cross-sectional validation study was conducted among patients with MetS attending a university primary care clinic in Selangor, Malaysia. Content validation, adaptation and face validation of E-SUQ were performed according to recommended guidelines. It underwent two rounds of content validation as major revision was required for item 5. Subsequently, the revised E-SUQ was face-validated by 10 participants. Psychometric evaluation was conducted using principal component analysis with varimax rotation to determine the underlying structure of E-SUQ. Internal consistency reliability was assessed using Cronbach’s α coefficient and the test-retest reliability was assessed using intraclass correlation coefficient (ICC (2,k)). A total of 205 patients participated in the study. The item-level content-validity-index (I-CVI) for item 5 improved from 0.57 to 1.0 after the second round of content validation. The final S-CVI/Ave value for ESUQ was >0.90. The item-level face-validity-index (I-FVI) ranged between 0.9 and 1.0. Kaiser-Meyer-Olkin value of 0.871 and Bartlett’s test of sphericity p-value of <0.05 indicated good sample adequacy for factor analysis. Two factors with eigenvalues of >1 were extracted according to the Kaiser’s Criteria. The two extracted factors explained 60.6% of the cumulative percentage of variance. The elbow of the scree plot occurred between the second and third component, suggesting two factors to be retained. The two factors were consistent with “Positive” and “Negative” tone model. The overall Cronbach’s α coefficient was 0.77, indicating good internal reliability. The overall ICC was 0.85, indicating good reproducibility. The E-SUQ is shown to be valid, reliable and stable to measure the usability of a self-management booklet among patients with MetS in a university primary care clinic in Malaysia.

Adaptation and Psychometric Validation of the EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) among Patients with Metabolic Syndrome in Primary Care

Background COVID-19 pandemic has impacted several aspects of health care services worldwide. Our aim was to study its influence on the case volume, success rate and complication rate of ERCP. Method All patients who underwent ERCP one-year before and after applying COVID-19 safety measures at Qena university hospital were included. Data were collected from the patients' records, analyzed and compared. Result A total of 250 patients were subjected to ERCP between April 1, 2019 and March 31, 2021, mean age 52±18. There was 5% increase in case volume after applying COVID-19 safety measures than before (128 vs 122) and the total procedure time was significantly shorter (42 versus 46 minutes, p=0.04). The overall success rate and complication rate showed no significant difference. Procedure success significantly corelated to cannulation attempts and total procedure time in both groups, and serum bilirubin and cannulation time in patients before COVID-19, and ALP in patients after. ERCP related complications significantly correlated with cannulation attempts in both groups, and ALP, INR, cannulation time and total procedure time in patients before COVID-19, and platelets count and amylase after. Two patients were confirmed COVID-19 cases at the time of ERCP, therapeutic targets were achieved in both with smooth post-ERCP recovery. Three out of 9 ERCP team members have caught mild to moderate COVID-19 infection and recovered after receiving proper management. Conclusion Our result showed no negative impact of using COVID-19 safety measures and precautions on the case-volume, indications, overall outcome or complication rate of ERCP.

Impact of COVID-19 pandemic on endoscopic retrograde cholangiopancreatography; a single center experience.

BACKGROUND: Occupational exposure seriously threatens the physical and mental health of professionals and has become an important public health problem. In clinical medical and nursing work, medical staff, especially nursing staff, are faced with the status quo of occupational exposure with high risk, serious harm, and severe situation. Therefore, a sound management system must be established to control the occupational exposure of nurses. AIMS: According to the PRECEDE management model, evaluate the operating room nurses' knowledge, belief, and behavior scores on the protection of surgical smoke, understand their awareness of surgical smoke and the current status of protection, improve the mastery rate and protection compliance of surgical smoke-related knowledge in the operating room, reduce the harm of surgical smoke to the human body, and provide a basis for smoke protection.Materials and methods. 125 doctors working in the operating room of our hospital were selected as the control group of this study, and 112 nonsmoke-exposed nurses working in the operating room of our hospital were selected as the observation group. The nurses' knowledge-belief behavior scores and self-evaluation scores of smoke influence were counted before and after the intervention in the operating room. SPSS25.0 was used to process the data. Tests and repeated measures analysis of variance were used to compare the effects before and after intervention. RESULTS: After one month of intervention, the knowledge scores of nurses in the operating room on the protection of surgical smoke increased significantly, and the difference was significant (P < 0.05); the scores of related concepts, physical properties, chemical properties, and authoritative protection standards increased significantly (P < 0.05). There was no significant increase in the scores of smoke hazards (P > 0.05); the attitude of smoke protection increased significantly, which was statistically significant (P < 0.05); and the behavior compliance of smoke protection was significantly increased, which was statistically significant (P < 0.05). After one month of intervention, the self-evaluation score of smoke effect of operating room nurses decreased significantly, and the difference was statistically significant (P < 0.05). The data was analyzed by repeated measure analysis of variance. The knowledge of surgical smoke (F = 65.570, P < 0.001), attitude (F = 78.307, P < 0.001), and behavior (F = 403.015, P < 0.001) scores gradually increased. The observation group's total cholesterol, low-density lipoprotein cholesterol, and the proportion of low-density lipoprotein cholesterol were higher than that of the control group, and the proportion of high-density lipoprotein cholesterol was lower than that of the control group. The difference was statistically significant P < 0.05. CONCLUSION: After the intervention of operating room nurses under the guidance of PRECEDE management mode, the theoretical knowledge of operating room nurses is effectively improved, the operations are standardized, the self-evaluation scores of smoke influence are reduced, and the safety level of operating room is improved. More importantly, the health of nursing staff is fully guaranteed.

The Nursing Effect of PRECEDE Management on Occupational Exposure to Surgical Smoke: Based on a Randomized Controlled Study

COVID-19 is caused by SARS-CoV-2 infection and characterized by diverse clinical symptoms. Type I interferon (IFN-I) production is impaired and severe cases lead to ARDS and widespread coagulopathy. We propose that COVID-19 pathophysiology is initiated by SARS-CoV-2 gene products, the NSP1 and ORF6 proteins, leading to a catastrophic cascade of failures. These viral components induce signal transducer and activator of transcription 1 (STAT1) dysfunction and compensatory hyperactivation of STAT3. In SARS-CoV-2-infected cells, a positive feedback loop established between STAT3 and plasminogen activator inhibitor-1 (PAI-1) may lead to an escalating cycle of activation in common with the interdependent signaling networks affected in COVID-19. Specifically, PAI-1 upregulation leads to coagulopathy characterized by intravascular thrombi. Overproduced PAI-1 binds to TLR4 on macrophages, inducing the secretion of proinflammatory cytokines and chemokines. The recruitment and subsequent activation of innate immune cells within an infected lung drives the destruction of lung architecture, which leads to the infection of regional endothelial cells and produces a hypoxic environment that further stimulates PAI-1 production. Acute lung injury also activates EGFR and leads to the phosphorylation of STAT3. COVID-19 patients’ autopsies frequently exhibit diffuse alveolar damage (DAD) and increased hyaluronan (HA) production which also leads to higher levels of PAI-1. COVID-19 risk factors are consistent with this scenario, as PAI-1 levels are increased in hypertension, obesity, diabetes, cardiovascular diseases, and old age. We discuss the possibility of using various approved drugs, or drugs currently in clinical development, to treat COVID-19. This perspective suggests to enhance STAT1 activity and/or inhibit STAT3 functions for COVID-19 treatment. This might derail the escalating STAT3/PAI-1 cycle central to COVID-19.

An aberrant STAT pathway is central to COVID-19

BACKGROUND: Chronic spinal pain is one of the most common diseases in the United States. Underserved patients are most affected, and disproportionately may use opioid medications as they lack access to other therapies. It is therefore important to develop systems to treat spinal pain within the primary medical home. METHODS: We designed a prospective observational pilot study at a community health center to measure the effectiveness of two interventions among an underserved population: a multidisciplinary pain team and chiropractic care. Study outcomes were pain and functional disability measured by the Pain Disability Questionnaire (PDQ), and reduction of opioid dose at baseline and 6-12 months. Multivariate linear regression was used to determine associating factors for change in PDQ scores. RESULTS: Thirty-five individuals completed baseline and follow-up PDQs from August 2018 to May 2020. Overall, the mean baseline PDQ was 92.4 +/− 6.1 and the mean follow-up PDQ was 81.9 +/− 7.7, resulting in a mean improvement of −10.6 (95% CI 1.2 - −22.3, P = .08). Participants in the chiropractic team (mean change −25.0, P = .01) and those completing the study before COVID-19 (mean change = −22.6, P < .01) were found to have significantly greater improvement at follow-up. CONCLUSION: This observational study within a community health center resulted in improvement in spinal pain and disability with chiropractic care versus a multidisciplinary pain team. Offering similar services in primary care may help to address pain and disability, and hopefully limit external referrals, advanced imaging, and opioid prescriptions.

Integrating a Multidisciplinary Pain Team and Chiropractic Care in a Community Health Center: An Observational Study of Managing Chronic Spinal Pain

Mobile touch screen devices (smartphones and tablet computers) have become an integral part of many parents' and children's lives, with this interaction linked to physical, mental and social outcomes. Despite the known importance of parent-child attachment, evidence on the association between device use and attachment was yet to be reviewed. Following protocol pre-registration, databases were searched, papers screened, and methodological quality assessed. Three papers met the inclusion criteria, and reported some negative associations between duration of parent/child smartphone use and attachment outcomes. A narrative synthesis on two groups of related papers found child time using any screen technology (including television viewing), and child "problematic" internet, mobile phone, gaming and social media use, was negatively associated with attachment outcomes. Currently there is limited direct evidence on any association between time parents or children spend using these devices and parent-child attachment to support time guidelines for families and professionals working with families.Practitioner Summary: Many parents and children regularly spend time using smartphones and tablet computers. This systematic review found limited evidence evaluating associations between child/adolescent or parent time using devices and parent-child attachment. Until quality evidence exists, practitioners should be alert to potential impacts of device use on family relationships and child outcomes.

The association of mobile touch screen device use with parent-child attachment: A systematic review.

The seventh human coronavirus SARS-CoV2 belongs to the cluster of extremely pathogenic coronaviruses including SARS-CoV and MERS-CoV, which can cause fatal lower respiratory tract infection. Likewise, SARS-CoV2 infection can be fatal as the disease advances to pneumonia, followed by acute respiratory distress syndrome (ARDS). The development of lethal clinical symptons is associated with an exaggerated production of inflammatory cytokines, referred to as the cytokine storm, is a consequence of a hyperactivated immune response aginst the infection. In this article, we discuss the pathogenic consequences of the cytokine storm and its relationship with COVID-19 associated risk factors. The increased pro-inflammatory immune status in patients with risk factors (diabetes, hypertension, cardiovascular disease, COPD) exacerbates the Cytokine-storm of COVID-19 into a 'Cytokine Super Cyclone'. We also evaluate the antiviral immune responses provided by BCG vaccination and the potential role of 'trained immunity' in early protection against SARS-CoV2.

A cytokine super cyclone in COVID-19 patients with risk factors: the therapeutic potential of BCG immunization

An unprecedented year highlighted the essential care nurses provide.

A Look Back at the Year of the Nurse and the Midwife

This paper presents a compression study of electrocardiogram (ECG) signals for e-Health cardiac online diagnostic systems. The study uses 75 real electrocardiogram records sampled with continuous-time level-crossing (LC) analog-to-digital converter (ADC). This signal-dependent LC-ADC compresses signals compared to conventional ADC but further compression is needed especially for long-time monitoring applications. The orthogonal matching pursuit algorithm is simulated to evaluate ECG compression with 54 orthogonal and biorthogonal wavelets. For LC-ADC amplitude output compression, Biorthogonal3.1 (bior3.1) wavelet achieves optimal performances in terms of compression ratio (CR) while ensuring 2-% percentage root-mean-square difference (PRD). The PRD must be limited to this value to ensure a very good quality signals after decompression. For circuit implementation purposes, bior3.1 wavelet is proposed as a multiplier-free decomposition step and a noncomplex global and hard thresholding process is achieved. The average CR is 63% and PRD varies between 0.1 and 2.1% leading to a very good diagnostic quality.

On the Wavelet-based Compressibility of Continuous-Time Sampled ECG Signal for e-Health Applications

The CoronaVirus (COVID19) made the higher education establishment take on urgent measures when all the students were prohibited from entering the university not to catch the disease, but the educational process was not to be stopped. Distance education tools were to be applied and digital platforms of the universities were to be checked. This paper deals with the experience of the National Research South Ural University. The courses of all the schools and institutes of the University were conducted based on the platform Digital SUSU. The example of the courses for second language learning was discussed. Fifty students of bachelor's and master's degrees were respondents in this research. The students answered the questions of the questionnaire on Google Forms and then were interviewed. The results suggest that the most interesting task on the planform Digital SUSU was a video with tasks and vocabulary exercises. However, among the most useful, according to the students' opinion were grammar, vocabulary, and reading tasks. The students were also asked to discuss the advantages and disadvantages of such remote learning. The most frequently mentioned advantages were the ability to study at home and the absence of the necessity to look smart. However, the disadvantages were more varied, including absence of communication, no face to face contact, too much homework, and too many written tasks.

Distance Learning Practices on the Example of Second Language Learning during Coronavirus Epidemic in Russia

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are two high-volume procedures that were delayed due to COVID-19. Questions/Purposes: To help strategize an effective return to elective orthopedic surgery, we aimed to quantify the volume of THA and TKA cases delayed across the USA and estimate the time required to care for these patients when non-urgent surgery resumes. Methods: Population-level data was used to estimate monthly THA and TKA procedural volume from 2011 to 2017. Using linear regression, we used this data to project monthly procedural volumes for 2020 to 2023. Nine different permutations were modeled to account for variations in case delay rates (50%, 75%, 100%) and in resumption of non-urgent procedure timing. Two recovery pathways using the highest volume month as a surrogate for maximum operative capacity, and a second using the highest month + 20% were used to simulate a theoretical expansion of current capacity. Results: The projected national volume of delayed cases was 155,293 (mid-March through April; 95% CI 142,004 to 168,580), 260,806 (through May; 95% CI 238,658 to 282,952), and 372,706 (through June; 95% CI 341,699 to 403,709). The best- and worst-case scenarios for delayed cases were 77,646 (95% CI 71,002 to 84,290) and 372,706 (95% CI 341,699 to 403,709), respectively. The projected catch-up time varied between 9 and nearly 35 months for the best- and worst-case scenarios. The addition of 20% increased productivity decreased this time to between 3.21 and 11.59 months. Conclusion: The COVID-19 pandemic has generated a significant backlog of THA and TKA procedures. Surgeons, administrators, and policymakers should account for these modeled estimates of case volume delays and projected demands.

Quantifying the Backlog of Total Hip and Knee Arthroplasty Cases: Predicting the Impact of COVID-19

Background: Robotic surgery is well established across multiple surgical specialities in the United Kingdom (UK) and Republic of Ireland (ROI). We aimed to elucidate current surgical trainee experience of and attitudes to robotic surgery in a surgical training programme across the UK and ROI to determine the future role of robotic surgery in international surgical training programmes. Methods: A pan-specialty trainee cross-sectional study was performed on behalf of the Association of Surgeons in Training (ASiT) using mixed-methodology. Round 1: a digital questionnaire was disseminated to all ASiT members. Round 2: ‘live-polling’ was performed prior to and following the Robotic Surgery plenary session convened at the ASiT 2020 International Conference (Birmingham). Data analysis was performed using a combination of quantitative and qualitative methods. Results: Three hundred and four responses were analysed (n = 244 digital questionnaire, n = 60 live-polling). Overall, 73.8% (n = 180) of trainees would value greater access to robotic surgery training. 73.4% (n = 179) believed that robotic surgery was important for the future of their desired specialty and 77.2% (n = 156) believed it should be incorporated into formal surgical training. Qualitative analysis identified that trainees believe that robotic training should have a formal role in surgical training. Perceived disadvantages of robotic surgery experience in surgical training included expense and the current impact of consultant robotic learning curves on training. Conclusion: Current surgical trainees desire greater access to robotic surgery in surgical training. Robotic surgery is developing an increasing role in current surgical practice and it is important that it is introduced in a timely, evidence-based fashion to surgical trainees at an appropriate stage of training.

Surgical trainee experience and opinion of robotic surgery in surgical training and vision for the future: a snapshot study of pan-specialty surgical trainees

To investigate the clinical value of changes in the subtypes of peripheral blood lymphocytes and levels of inflammatory cytokines in patients with COVID-19, the total numbers of lymphocytes and CD4+ lymphocytes and the ratio of CD4+/CD8+ lymphocytes were calculated and observed in different groups of patients with COVID-19 The results show that the lymphocytopenia in patients with COVID-19 was mainly manifested by decreases in the CD4+ T lymphocyte number and the CD4+/CD8+ ratio The decreased number of CD4+ T lymphocytes and the elevated levels of TNF-α and IL-6 were correlated with the severity of COVID-19 disease

The changes of the peripheral CD4+ lymphocytes and inflammatory cytokines in Patients with COVID-19

In their response to the COVID-19 outbreak, governments face the dilemma to balance public health and economy. Mobility plays a central role in this dilemma because the movement of people enables both economic activity and virus spread. We use mobility data in the form of counts of travellers between regions, to extend the often-used SEIR models to include mobility between regions. We quantify the trade-off between mobility and infection spread in terms of a single parameter, to be chosen by policy makers, and propose strategies for restricting mobility so that the restrictions are minimal while the infection spread is effectively limited. We consider restrictions where the country is divided into regions, and study scenarios where mobility is allowed within these regions, and disallowed between them. We propose heuristic methods to approximate optimal choices for these regions. We evaluate the obtained restrictions based on our trade-off. The results show that our methods are especially effective when the infections are highly concentrated, e.g. around a few municipalities, as resulting from superspreading events that play an important role in the spread of COVID-19. We demonstrate our method in the example of the Netherlands. The results apply more broadly when mobility data are available.

Trade-offs between mobility restrictions and transmission of SARS-CoV-2

Rhinoviruses are a frequent cause of the common cold and more serious illnesses, such as otitis media, sinusitis and asthma exacerbations and, more infrequently, have been implicated in lower airway infections, including pneumonia and exacerbations of chronic obstructive pulmonary disease and cystic fibrosis. Diagnosis of rhinovirus infections is best achieved using sensitive and specific reverse-transcription (RT)-PCR assays. The article by Do et al. describes the development and validation of a new one-step, TaqMan RT-PCR assay targeting the rhinovirus noncoding region for the detection of rhinovirus RNA in respiratory specimens from children with upper respiratory symptoms. The assay was rapid and specific and sensitive compared with cell culture. The recent use of RT-PCR assays for the detection of rhinoviruses in clinical specimens has provided more accurate information about the disease burden and epidemiology of these ubiquitous viruses.

Molecular detection of rhinoviruses.

BACKGROUND: Recent COVID‐19 lockdown restrictions resulted in reduced access to educational, professional and social support systems for children with intellectual disabilities and their carers. AIM: The aim of this study was to gain insight into the ways mothers of children with intellectual disabilities coped during the first 2020 lockdown period. METHODS: Eight mothers of children with intellectual disabilities were interviewed. The recordings of these interviews were subjected to a thematic analysis. RESULTS: Three main themes were identified: carrying the burden; a time of stress; and embracing change and looking to the future. CONCLUSIONS: All mothers experienced increased burden and stress. However, some also described some positive impact of lockdown conditions on them as well as on their child's well‐being and behaviour. These findings are discussed in the light of the (Journal of Applied Research in Intellectual Disabilities, 33, 2020, 1523) survey results on parental coping and suggestions for future service provision during pandemic conditions are proposed.

The experiences of mothers of children and young people with intellectual disabilities during the first COVID‐19 lockdown period

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious zoonotic pathogen that has exacted heavy public health, social and economic tolls. In February 2020, the World Health Organization acronymed the disease caused by SARS-CoV-2 as COVID-19, for coronavirus disease 2019. The number of confirmed COVID-19 infections, which has been detected in at least 103 countries, has reached 1,970,225 worldwide as of April 14, 2020 with 124,544 deaths, according to the U.S. Centers for Disease Control and Prevention (CDC). Many cases of COVID-19 resolve quickly. However, the disease, which, like other respiratory pathogens that cause common cold symptoms is believed to be transmitted through respiratory droplets. Infection with COVID-19 can also lead to significant morbidity and death; this is particularly the case for cancer patients. Moreover, because the signs and symptoms of COVID-19 are easily misattributed to the sequelae of cancer itself, such as pulmonary embolism, or its treatment, such as nausea and diarrhea, diagnosis may be delayed or missed. Potential COVID-19 rule out criteria, based on the Wells' criteria for pulmonary embolism, another protean disease entity, are provided as a decision-making aid. This review summarizes the current understanding of the transmission, clinical presentation, diagnosis and differential diagnosis, pathogenesis, rationale to treat the cancer or not, treatment and prevention of COVID-19 with an emphasis on implications in cancer.

COVID-19 and cancer: A guide with suggested COVID-19 rule-out criteria to support clinical decision-making

Treating patients with COVID-19 is expensive, thus it is essential to identify factors on admission associated with hospital length of stay (LOS) and provide a risk assessment for clinical treatment. To address this, we conduct a retrospective study, which involved patients with laboratory-confirmed COVID-19 infection in Hefei, China and being discharged between January 20 2020 and March 16 2020. Demographic information, clinical treatment, and laboratory data for the participants were extracted from medical records. A prolonged LOS was defined as equal to or greater than the median length of hospitable stay. The median LOS for the 75 patients was 17 days (IQR 13–22). We used univariable and multivariable logistic regressions to explore the risk factors associated with a prolonged hospital LOS. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated. The median age of the 75 patients was 47 years. Approximately 75% of the patients had mild or general disease. The univariate logistic regression model showed that female sex and having a fever on admission were significantly associated with longer duration of hospitalization. The multivariate logistic regression model enhances these associations. Odds of a prolonged LOS were associated with male sex (aOR 0.19, 95% CI 0.05–0.63, p = 0.01), having fever on admission (aOR 8.27, 95% CI 1.47–72.16, p = 0.028) and pre-existing chronic kidney or liver disease (aOR 13.73 95% CI 1.95–145.4, p = 0.015) as well as each 1-unit increase in creatinine level (aOR 0.94, 95% CI 0.9–0.98, p = 0.007). We also found that a prolonged LOS was associated with increased creatinine levels in patients with chronic kidney or liver disease (p < 0.001). In conclusion, female sex, fever, chronic kidney or liver disease before admission and increasing creatinine levels were associated with prolonged LOS in patients with COVID-19.

Risk factors on admission associated with hospital length of stay in patients with COVID-19: a retrospective cohort study

COVID-19 has brought tremendous and abrupt threats to various aspects of our daily lives, from school and work to interpersonal relationships. Self-compassion is put forth as a salutogenic perspective on oneself that buffers the adverse mental health impacts of these threats. During the peak of a local outbreak in Hong Kong in Spring 2020, 761 participants completed questionnaires on self-compassion, perceived threats, as well as perceived benefits and psychological distress. Controlling for demographic variables, negative indicators of self-compassion (aka self-coldness) was found to intensify the impacts of threats on psychological distress. The positive indicators of self-compassion also moderated the link between threats and perceived benefits, such that perceived benefits tend to be less related to threats in participants with higher self-compassion. Our findings highlight the impacts of both positive and negative indicators of self-compassion on the adjustment to such unprecedented challenges, and point to the possibility of enhancing people's resilience through fostering self-compassion and alleviating self-coldness.

Self-Compassion Buffers the Adverse Mental Health Impacts of COVID-19-Related Threats: Results From a Cross-Sectional Survey at the First Peak of Hong Kong's Outbreak

The ongoing COVID-19 pandemic has posed a global threat to human health. In order to prevent the spread of this virus, many countries have imposed travel restrictions. This difficult situation has dramatically affected the airline industry by reducing the passenger volume, number of flights, airline flow patterns, and even has changed the entire airport network, especially in Northeast Asia (because it includes the original disease seed). However, although most scholars have used conventional statistical analysis to describe the changes in passenger volume before and during the COVID-19 outbreak, very few of them have applied statistical assessment or time series analysis, and have not even examined how the impact may be different from place to place. Therefore, the purpose of this study was to identify the impact of COVID-19 on the airline industry and affected areas (including the origin-destination flow and the airport network). First, a Clustering Large Applications (CLARA) algorithm was used to group numerous origin-destination (O-D) flow patterns based on their characteristics and to determine if these characteristics have changed the severity of the impact of each cluster during the COVID-19 outbreak. Second, two statistical tests (the paired t-test and the Wilcoxon signed-rank test) were utilized to determine if the entire airport network and the top 30 hub airports changed during COVID-19. Four centrality measurement indices (degree, closeness, eigenvector, and betweenness centrality) of the airports were used to assess the entire network and ranking of individual hub airports. The study data, provided by The Official Aviation Guide (OAG) from December 2019 to April 2020, indicated that during the COVID-19 outbreak, there was a decrease in passenger volume (60%–98.4%) as well as the number of flights (1.5%–82.6%). However, there were no such significant changes regarding the popularity ranking of most airports during the outbreak. Before this occurred (December 2019), most hub airports were in China (April 2020), and this trend remain similar during the COVID-19 outbreak. However, the values of the centrality measurement decreased significantly for most hub airports due to travel restrictions issued by the government.

The impact of the COVID-19 pandemic on O-D flow and airport networks in the origin country and in Northeast Asia

Meteorological parameters are important factors that have an influence on infectious diseases. The present study aimed to explore the correlation between the spread of COVID-19, temperature, and relative humidity. The effect of human-imposed control parameters in the form of lockdown on the dissipation of COVID-19 was also analyzed. Data were collected on the three study variables – temperature, relative humidity, and lockdown period – from nine of the most infected cities worldwide as well as information on changes in the number of COVID-19 patients from the beginning to a specific point in the lockdown period. A generalized regression model was applied to explore the effect of temperature and relative humidity on the change in daily new cases of COVID-19. The regression analysis did not find any significant correlation between temperature, humidity, and change in number of COVID-19 cases. Analysis of the cities with wide-ranging temperature variations showed a negative correlation of COVID-19 transmission (p=0.079) with temperature but a relatively nonsignificant correlation with relative humidity (p=0.198). The number of total deaths was also higher in low-temperature countries compared with high-temperature countries. The specific growth rate in COVID-19 cases was decreased by more than 66% after implementation of a lockdown. This growth rate was exponentially decreased over time through the proper implementation of lockdown. Analysis of the real-case scenario and application of predictive models showed that for New York, Lombardy, and Madrid more than 120 days of strict lockdown was required for complete control of the transmission of COVID-19.

Coronavirus COVID-19 outbreak and control: effect of temperature, relative humidity, and lockdown implementation

OBJECTIVE: Since the beginning of the COVID‐19 epidemic, a large number of guidelines on diagnosis and treatment of COVID‐19 have been developed, but the quality of those guidelines and the consistency of recommendations are unclear. The objective of this study is to evaluate the quality of the diagnosis and treatment guidelines on COVID‐19 and analyze the consistency of the recommendations of these guidelines. METHODS: We searched for guidelines on diagnosis and/or treatment of COVID‐19 through PubMed, CBM, CNKI, and WanFang Data, from January 1, 2020 to August 31, 2020. In addition, we also searched official websites of the US CDC, European CDC and WHO, and some guideline collection databases. We included diagnosis and/or treatment guidelines for COVID‐19, including rapid advice guidelines and interim guidelines. Two trained researchers independently extracted data and four trained researchers evaluated the quality of the guidelines using the AGREE II instruments. We extracted information on the basic characteristics of the guidelines, guideline development process, and the recommendations. We described the consistency of the direction of recommendations for treatment and diagnosis of COVID‐19 across the included guidelines. RESULTS: A total of 37 guidelines were included. Most included guidelines were assessed as low quality, with only one of the six domains of AGREE II (clarity of presentation) having a mean score above 50%. The mean scores of three domains (stakeholder involvement, the rigor of development and applicability) were all below 30%. The recommendations on diagnosis and treatment were to some extent consistent between the included guidelines. Computed tomography (CT), X‐rays, lung ultrasound, RT‐PCR, and routine blood tests were the most commonly recommended methods for COVID‐19 diagnosis. Thirty guidelines were on the treatment of COVID‐19. The recommended forms of treatment included supportive care, antiviral therapy, glucocorticoid therapy, antibiotics, immunoglobulin, extracorporeal membrane oxygenation (ECMO), convalescent plasma, and psychotherapy. CONCLUSIONS: The methodological quality of currently available diagnosis and treatment guidelines for COVID‐19 is low. The diagnosis and treatment recommendations between the included guidelines are highly consistent. The main diagnostic methods for COVID‐19 are RT‐PCR and CT, with ultrasound as a potential diagnostic tool. As there is no effective treatment against COVID‐19 yet, supportive therapy is at the moment the most important treatment option.

Consistency of recommendations and methodological quality of guidelines for the diagnosis and treatment of COVID‐19

Background and Aims Vaccination against SARS-CoV-2 has rapidly expanded, however clinical trials excluded patients taking immunosuppressive medications such as those with inflammatory bowel disease (IBD). Therefore, we explored real-world effectiveness of COVID-19 vaccination on subsequent infection in IBD patients with diverse exposure to immunosuppressive medications. Methods This was a retrospective cohort study of patients in the Veterans Health Administration with IBD diagnosed prior to 12/18/20, the start date of the VHA patient vaccination program. IBD medication exposures included 5-aminosalicylic acid, thiopurines, anti-tumor necrosis factor biologic agents, vedolizumab, ustekinumab, tofacitinib, methotrexate, and corticosteroid use. We used inverse probability weighting and Cox regression with vaccination status as a time-updating exposure, and computed vaccine effectiveness from incidence rates. Results The cohort comprised 14,697 patients, 7,321 of whom received at least one vaccine dose (45.2% Pfizer, 54.8% Moderna). The cohort had median age 68 years, was 92.2% male, 80.4% white, and 61.8% with ulcerative colitis. In follow-up data through April 20, 2021, unvaccinated individuals had the highest raw proportion of SARS-CoV-2 infection (197 [1.34%] versus 7 [0.11%] fully vaccinated). Full vaccination status, but not partial vaccination status, was associated with a 69% reduced hazard of infection relative to an unvaccinated status (hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.17-0.56, p<0.001), corresponding to an 80.4% effectiveness. Conclusion Full vaccination (>7 days after the 2nd dose) against SARS-CoV-2 infection has an approximately 80.4% effectiveness in a broad IBD cohort with diverse exposure to immunosuppressive medications. These results may serve to increase patient and provider willingness to pursue vaccination in these settings.

Effectiveness of SARS-CoV-2 vaccination in a Veterans Affairs Cohort of Inflammatory Bowel Disease Patients with Diverse Exposure to Immunosuppressive Medications

The discovery of incretin-based medications represents a major therapeutic advance in the pharmacological management of type 2 diabetes mellitus (T2DM), as these agents avoid hypoglycemia, weight gain, and simplify the management of T2DM. Dipeptidyl peptidase-4 (CD26, DPP4) inhibitors are the most widely used incretin-based therapy for the treatment of T2DM globally. DPP4 inhibitors are modestly effective in reducing HbA1c (glycated hemoglobin) (≈0.5%) and while these agents were synthesized with the understanding of the role that DPP4 plays in prolonging the half-life of incretins such as glucagon-like peptide-1 and gastric inhibitory peptide, it is now recognized that incretins are only one of many targets of DPP4. The widespread expression of DPP4 on blood vessels, myocardium, and myeloid cells and the nonenzymatic function of CD26 as a signaling and binding protein, across a wide range of species, suggest a teleological role in cardiovascular regulation and inflammation. Indeed, DPP4 is upregulated in proinflammatory states including obesity, T2DM, and atherosclerosis. Consistent with this maladaptive role, the effects of DPP4 inhibition seem to exert a protective role in cardiovascular disease at least in preclinical animal models. Although 2 large clinical trials suggest a neutral effect on cardiovascular end points, current limitations of performing trials in T2DM over a limited time horizon on top of maximal medical therapy must be acknowledged before rendering judgment on the cardiovascular efficacy of these agents. This review will critically review the science of DPP4 and the effects of DPP4 inhibitors on the cardiovascular system.

DPP4 in cardiometabolic disease: recent insights from the laboratory and clinical trials of DPP4 inhibition.

Pneumonia Detection has been a real problem for the last few centuries. Detecting Pneumonia has been a job for the skilled, such as doctors and medical practitioners. Visiting doctors in this time in many countries is very tough with Covid-19 on the rise and stricter lockdown regulations. Deep Learning has helped build many systems and algorithms over the years to detect pneumonia using X-ray images. Such Deep Learning models are first trained on many X-ray images that would be collected from multiple hospitals and diagnostic centers and then can be deployed centrally for people to use them. However, building such models is impeded by the problem of garnering mass data from hospitals due to data confidentiality between patients and hospitals. For that, we propose a system where detecting Pneumonia would be done using a Deep Learning model with a Federated Learning approach and achieve an accuracy of around 90%. This will build a central model by training local models in different hospitals with their own data, maintaining all patient data privacy. © 2021 IEEE.

A Federated Learning Approach to Pneumonia Detection

OBJECTIVE: The Impact of Weight on Quality of Life—Kids is a self-reported weight-related quality of life measure that has been validated for children and adolescents aged between 11 and 19. Impact of Weight on Quality of Life—Kids does not have a Turkish version. The aim of this study was to explore the reliability and validity of the Impact of Weight on Quality of Life—Kids in Turkish. MATERIALS AND METHODS: The Impact of Weight on Quality of Life—Kids was translated into Turkish using Mapi Research Institute's suggested international translation technique. The psychometric evaluation included test–retest reliability, internal consistency, discriminant validity, concurrent validity, exploratory factor analysis, and confirmatory factor analysis. RESULTS: For the total score, the internal consistency of the scale (Cronbach's alpha coefficient) was 0.93. The item-total score correlation coefficients ranged from 0.178 to 0.785. The test-retest coefficients were found to be 0.94 for the total score and the subscales ranged from 0.66 to 0.89 after 2 weeks. Discriminant validity analysis demonstrated that the instrument differentiated well between the obese and non-obese samples. Five variables were discovered via factor analysis that explained 66.9% of the total variation. The chi-square/degree of freedom ratio value was 3.535, the comparative fit index value was 0.834, and the value of root mean square error of approximation was 0.10, as determined by confirmatory factor analysis. CONCLUSION: Our results demonstrated the adequate reliability and validity of the Impact of Weight on Quality of Life—Kids, suggesting that this scale is a useful tool for screening Turkish children and adolescents for weight-related quality of life.

Reliability and Validity of the Turkish Version of Impact of Weight on Quality of Life for Kids

In the current study, an observational procedure, recorded in video, was used to evaluate the quality of parent-child interactions in a sample of vulnerable Portuguese families (n = 47) with school-aged children followed by Child Protective Services (CPS). The study sought to explore if the families presented different profiles of parent-child interaction quality, and to characterize such profiles in terms of discrete behaviors observed, parenting outcome variables, and families’ sociodemographic and CPS referral characteristics. The parent-child dyads took part in a 15 minutes structured task and parents completed self-report measures (affection, parenting behaviors, and stress). Discrete behaviors of parents and children during interactions were coded with a micro-analytic coding procedure. The global dimensions of the parents’ interactions were coded with a global rating system. A latent profile analysis, estimated with global dimensions, identified two subgroups, one subgroup in which parents displayed higher quality interactions (n = 12), and another subgroup in which parents displayed lower quality interactions (n = 35). Further analyses comparing the subgroups determined that the higher quality subgroup presented more positive behaviors, and the lower quality subgroup presented more negative behaviors during the interactions. No further differences or associations were found regarding the parenting outcome variables, and the families’ sociodemographic and CPS referral characteristics. The findings are in line with prior studies, suggesting that vulnerable families may frequently present depleted parent-child interactions. However, given the small sample size, future studies should replicate the described procedures and analyses in larger sample sizes.

An Evaluation of the Quality of Parent-Child Interactions in Vulnerable Families That Are Followed by Child Protective Services: A Latent Profile Analysis

The COVID-19 pandemic had a major impact on the economy around the world, damaging many areas of daily life. The industrial sector has been affected by the effects of industrial closures, reduced economic activity, and disruptions in logistics and transportation. The damage caused by the crisis has not yet been specifically assessed, as the industrial sector was not the most affected by the pandemic compared to other sectors of the economy. The subject of the study is the industrial sector of Ukraine and the EU. The aim of the article is to assess the impact of the COVID-19 pandemic on industrial development in Ukraine and the EU, as well as to propose economic policy measures to achieve stabilization in the industrial sector. Since industry is the foundation of economic growth and development, it is necessary to assess the depth of its decline and find possible solutions to get out of the recession. The theoretical analysis of the article is based on recent work by scientists in the field of industrial development, as well as on the authors' developments assessing the impact of the COVID-19 pandemic on the economy. The COVID-19 pandemic created the following problems for Ukraine's economy and industry: a decrease in aggregate global demand and a decline in business activity, which led to lower prices on world commodity markets;strengthening of government regulation;raw-material orientation of Ukraine's exports and the significant dependence of industrial enterprises on world prices for raw materials;transport and logistics problems with raw material supply chains;lower business expectations and reduced investment due to significant uncertainty. The findings showed that the coronavirus crisis hit the industrial sectors mainly in April 2020, leading to a 16.1% decline in industrial production in Ukraine and an 18.6% decline in the coal mining, oil and gas extraction were hit the hardest. The following measures to stabilize the industrial sector are proposed: support for domestic demand for the products of industries, namely metallurgy, machine building, and chemical industry, which are mainly export-oriented and very sensitive to changes in global demand;stimulation and development of high value-added production;acceleration of the digitalization process within national borders;support for the industrial sector in its pursuit of environmentally friendly production, and others.

Impact of the Covid-19 Pandemic on the Industrial Sector: Implications for Economic Policy

This study examines the relationship of pneumococcal vaccination rates, influenza, measles-mumps-rubella (MMR) diphtheria-tetanus-pertussis vaccinations (DTP), polio, Haemophilus influenzae type B (Hib), and Bacillus Calmette–Guerin (tuberculosis) vaccination rates to COVID-19 case and death rates for 51 nations that have high rates of COVID-19 testing and for which nearly complete childhood, at-risk adult and elderly pneumococcal vaccination data were available. The study is unique in a large number of nations examined, the range of vaccine controls, in testing effects of combinations of vaccinations, and in examining the relationship of COVID-19 and vaccination rates to invasive pneumococcal disease (IPD). Analysis of Italian regions and the states of the United States were also performed. Significant positive correlations were found between IPD (but not lower respiratory infections) and COVID-19 rates, while significant negative correlations were found between pneumococcal vaccination and COVID-19 rates. Influenza and MMR vaccination rates were negatively correlated with lower respiratory infection (LRI) rates and may synergize with pneumococcal vaccination rates to protect against COVID-19. Pneumococcal and influenza vaccination rates were independent of other vaccination rates. These results suggest that endemic rates of bacterial pneumonias, for which pneumococci are a sentinel, may set regional and national susceptibility to severe COVID-19 disease and death.

Pneumococcal and Influenza Vaccination Rates and Pneumococcal Invasive Disease Rates Set Geographical and Ethnic Population Susceptibility to Serious COVID-19 Cases and Deaths

The authors have set out to analyze the most recent Italian Constitutional Court jurisprudence (rulings n. 32 and 33/2021) on the issue of surrogacy, by contextualizing the underlying factors and possible implications. The judges argue that their decisions are grounded in the best interest of the minor, whether born from surrogate motherhood or from heterologous fertilization, and believe that a legislative intervention to regulate the issue can no longer be postponed. According to that rationale, the legislator should take into account the difference between surrogacy and heterologous fertilization, and therefore the recognition of intentional parenthood cannot be unconditional, but must be differentiated, depending on the fertilization technique used. (www.actabiomedica.it)

Same-sex parenting according to the Italian Constitutional Court: the need for legislative solutions

PURPOSE: The cemented Exeter V40 stem is known to migrate distally. Several previous studies have reported on the extent of stem migration and its influence on clinical outcome. However, no studies have investigated the influence of stem migration on Patient Reported Outcome Measures (PROM). METHODS: One hundred and twelve total hip arthroplasties (THA) were included in a 2-year follow-up using Radiostereometric Analysis (RSA). Patients were evaluated using the Oxford Hip Score (OHS) and EQ-5D-3L PROMs. The purpose of this study was to assess the influence of stem migration, measured by Maximum Total Point Motion (MTPM), on the 2-year postoperative score (OHS and EQ-5D). Furthermore, the influence of pre-operative PROM, age, gender, acetabular component and BMI was associated with the 2-year postoperative OHS and EQ-5D scores. RESULTS: MTPM was a non-significant predictor of the 2-year postoperative OHS (regression coefficient (B) = - 2.38 (CI - 5.44; .69)) and of the 2-year postoperative EQ-5D (B = - .01 (CI - .04; .02)). The only significant predictor of the 2-year postoperative OHS and 2-year postoperative EQ-5D was gender (B = 8.71 (CI 3.52; 13.90)) and (B = .13 (CI .07; .18)), respectively. CONCLUSION: Stem migration did not significantly influence PROMs at 2 years post-operatively. Using a patient-focused approach, our results seem to corroborate results reported by previous studies, showing that slow migration of the Exeter V40 stem does not seem to influence the clinical outcome.

The influence of migration of the exeter V40 stem on patient reported outcome measures: a 2-year follow-up of 112 total hip arthroplasties using radiostereometric analysis

COVID-19 is still a major pandemic threatening all the world. In Palestine, there were 26,764 COVID-19 cumulative confirmed cases as of 27th August 2020. In this paper, two statistical approaches, autoregressive integrated moving average (ARIMA) and k-th moving averages - ARIMA models are used for modeling the COVID-19 cumulative confirmed cases in Palestine. The data was taken from World Health Organization (WHO) website for one hundred seventy-six (176) days, from March 5, 2020 through August 27, 2020. We identified the best models for the above mentioned approaches that are ARIMA (1,2,4) and 5-th Exponential Weighted Moving Average - ARIMA (2,2,3). Consequently, we recommended to use the 5-th Exponential Weighted Moving Average - ARIMA (2,2,3) model in order to forecast new values of the daily cumulative confirmed cases in Palestine. The forecast values are alarming, and giving the Palestinian government a good picture about the next number of COVID-19 cumulative confirmed cases to review her activities and interventions and to provide some robust structures and measures to avoid these challenges.

Modeling Palestinian COVID-19 Cumulative Confirmed Cases: A Comparative Study

BACKGROUND: Several cases of coronavirus disease 2019 (COVID-19)-associated leukoencephalopathy have been reported. Although most cases involve hypoxia, the pathophysiological mechanism and neurologic outcomes of COVID-19-associated leukoencephalopathy remain unclear. CASE PRESENTATION: We report a case of COVID-19-associated leukoencephalopathy without severe hypoxia in a 65-year-old woman diagnosed with pyelonephritis. After the initiation of intravenous ceftriaxone, her fever resolved, but she developed an altered state of consciousness with abnormal behavior and, subsequently, a relapse fever. She was diagnosed with COVID-19 pneumonia and was intubated. Lung-protective ventilation with deep sedation and neuromuscular blockade were used for treatment. After cessation of sedative administration, her mental status remained at a Glasgow Coma Scale score of 3. COVID-19 was assumed to have caused leukoencephalopathy due to the absence of severe hypoxia or other potential causes. She subsequently showed gradual neurologic improvement. Three months after the COVID-19 diagnosis, she regained alertness, with a Glasgow Coma Scale score of 15. CONCLUSION: Clinicians should consider leukoencephalopathy in the differential diagnosis of consciousness disorders in patients with severe COVID-19, even in the absence of severe hypoxia. Gradual neurologic improvement can be expected in such cases.

COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report

BACKGROUND: National governments worldwide have implemented nonpharmaceutical interventions to control the COVID-19 pandemic and mitigate its effects. OBJECTIVE: The aim of this study was to investigate the prediction of future daily national confirmed COVID-19 infection growth—the percentage change in total cumulative cases—across 14 days for 114 countries using nonpharmaceutical intervention metrics and cultural dimension metrics, which are indicative of specific national sociocultural norms. METHODS: We combined the Oxford COVID-19 Government Response Tracker data set, Hofstede cultural dimensions, and daily reported COVID-19 infection case numbers to train and evaluate five non–time series machine learning models in predicting confirmed infection growth. We used three validation methods—in-distribution, out-of-distribution, and country-based cross-validation—for the evaluation, each of which was applicable to a different use case of the models. RESULTS: Our results demonstrate high R(2) values between the labels and predictions for the in-distribution method (0.959) and moderate R(2) values for the out-of-distribution and country-based cross-validation methods (0.513 and 0.574, respectively) using random forest and adaptive boosting (AdaBoost) regression. Although these models may be used to predict confirmed infection growth, the differing accuracies obtained from the three tasks suggest a strong influence of the use case. CONCLUSIONS: This work provides new considerations in using machine learning techniques with nonpharmaceutical interventions and cultural dimensions as metrics to predict the national growth of confirmed COVID-19 infections.

Machine Learning–Based Prediction of Growth in Confirmed COVID-19 Infection Cases in 114 Countries Using Metrics of Nonpharmaceutical Interventions and Cultural Dimensions: Model Development and Validation

ECMO is increasingly being used to manage severe ARDS with refractory hypoxemia and hypercapnia, and to facilitate lung-protective ventilation and minimize ventilator-associated lung injury. However, there is limited high-level evidence to support its use. Early randomized trials did not show a benefit, though these studies were hampered by high mortality rates, limited experience with ECMO, and antiquated technology. Since the advent of more advanced circuit components and increased experience with the use of this technology, survival rates with ECMO for ARDS have improved. There is only one randomized trial to date which used a more modern ECMO circuit. This trial, which has significant limitations, demonstrated a survival benefit from referral to a specialized center for consideration for ECMO. However, a prospective randomized trial comparing ECMO, using modern equipment, to standard-of-care mechanical ventilation has yet to be performed. There are no universally accepted guidelines for initiation of ECMO for ARDS, however suggested criteria include PaO(2) to FIO(2) ratio less than 80, uncompensated respiratory acidosis, and excessively high plateau airway pressures despite optimal ventilator management. Relative contraindications include prolonged ventilation at high airway pressures or high FIO(2), contraindications to anticoagulation, and concurrent severe, irreversible comorbidities.

Hypoxemic Respiratory Failure: Evidence, Indications, and Exclusions

PURPOSE The coronavirus (COVID-19) pandemic has changed how outpatient care is delivered in ophthalmology clinics, particularly with glaucoma care. This case series highlights the need for awareness of fogging and improper face mask fit as causes of standard automated perimetry artifacts in patients with ocular hypertension and glaucoma. CLINICAL PRESENTATIONS Six patients with the diagnosis of ocular hypertension, glaucoma suspect, or glaucoma underwent standard automated perimetry (24-2 or 10-2 SITA, Humphrey Field Analyzer) while wearing ear-loop surgical face masks. Due to patient complaints of fogging during the testing, low test reliability, and unexpected results, the tests were repeated after taping securely the mask to the bridge of the nose. CLINICAL FINDINGS Fogging may reduce visual field (VF) test reliability and induce artifacts that mimic glaucomatous defects. VF test reliability can be improved and artifacts minimized following mask taping. In 1 case there was worsening of VF defects after mask taping. This suggests that fogging may also disguise true VF defects. CONCLUSIONS Fogging can result in unreliable VF testing with glaucoma-like artifacts. Secure taping of the face mask to the nose bridge may minimize this problem and reduce unnecessary additional testing and follow-up visits.

Visual Field Artifacts in Glaucoma With Face Mask Use During the COVID-19 Pandemic.

Context: In the era of the SARS-CoV-2 virus pandemic, new scoring systems need to be developed to estimate the risk of COVID-19 complications aiding in the accurate prognosis. Improved scoring systems by combining multiple variables allow clinicians to optimize the allocation of limited medical resources for the best clinical outcomes. Methods: Published articles were selected that assessed the relationship between clinical, para-clinical, demographics, comorbidities, and outcomes of COVID-19 patients in a systematic review to develop a novel scoring system. Results: In this study, by summarizing the results of 97 studies and the experiences of experts, prognostic factors were determined and divided into four groups: Age, clinical symptoms, co-morbidities, and tests. Twenty-three published articles met the selection criteria and were included in this study. Accordingly, by the opinion of experts, prognostic factors were categorized into four main groups: Age, clinical symptoms, co-morbidities, and specific test results. Conclusions: This novel scoring model helps physicians to early identify critical COVID-19 patients and optimize patient management based on recent comprehensive data of the most significant predictive factors.

Development of a Novel Scoring System for Comprehensive COVID-19 Patient Evaluation: An Evidence-Based Systematic Review

El coronavirus ha generado una suerte de "histeria colectiva" en diversas poblaciones. Por lo tanto, nuestro objetivo fue validar un test que mida el fatalismo ante la posibilidad de contagio por el coronavirus. Se realizó un proceso de validación en cinco fases: Búsqueda de la literatura y construcción del primer borrador, juicio de fondo con 28 expertos, evaluación de forma con 280 personas, piloto para análisis factorial exploratorio en 389 personas (en ambas se contó con 17 ciudades de Perú) y confirmación de la validez del constructo final con 10 expertos. Los estadísticos de KMO (0,779) y Bartlett (572,6; gl = 21; p < 0,001) presentaron resultados aceptables y significativos. La varianza total explicada por los 7 ítems distribuidos en 2 factores es de 58,9%, lo cual es adecuado. Los análisis robustos muestran que la estructura factorial es satisfactoria (X2 = 21,161; p = 0,007; CFI = 0,984; GFI = 0,996; TLI = 0,957; RMSEA = 0,067 y RMSR = 0,033). Se generó una escala de 7 ítems para medir las medidas fatalistas que las personas podrían tener o tomar si es que llegasen a enfermarse del coronavirus

Fatalism due to the possibility of coronavirus infection: Generation and validation of an instrument (F-COVID-19)/ Fatalismo ante la posibilidad de contagio por el coronavirus: Generación y validación de un instrumento (F-COVID-19)

BACKGROUND: Coronavirus disease 2019 (COVID-19) has caused massive casualties, severe economic losses, and poses a threat to the world. This study’s primary objective was to analyze the hospital’s potential hazards of COVID-19 prevention and control. The second objective was to review the disaster plan and make recommendations to minimize the spread of COVID-19 in hospitals. METHODS: An expert group for the prevention and control of COVID-19 in the First People’s Hospital of Long-quanyi Dis-trict, Chengdu, China was established. We adopted the hazard vulnerability analysis (HVA) to risk-stratify potential hazards and calculated relative risk values. We used the Delphi expert consultation method to propose and implement targeted improvement measures for the top five potential hazards. Then, the effects before and after the intervention were compared. RESULTS: The top five hazards were: insufficient Personal Protective Equipment (PPE) (25.68%), inadequate diagnosis ability of clinicians (22.55%), and inadequate management strategies of patients and caregivers (22.38%), lack of professional ability of pre-checking and triage staff (16.96%), lack of knowledge of COVID-19 of medical staff (15.59%). After taking targeted improvement measures, the average score of the hospital staff’s COVID-19 knowledge test increased from 73.26 points to 90.44 points, the average test score of the outsourcing company employees increased from 68.55 to 89.75 points. The differences were statistically significant (P<0.05). CONCLUSION: HVA can be used to systematically risk-stratify potential threats, measure the probability of those potential hazards, and develop various hospital prevention and control measures for COVID-19 epidemics.

The Application of Hazard Vulnerability Analysis in the Prevention and Control of COVID-19 in Medical Institutions

The number of new daily SARS-CoV-2 infections is frantically rising in almost every country of the EU. The phenomenological explanation offered is a new mutation of the virus, first identified in the UK. We use publicly available data in combination with a controlled SIR model, which captures the effects of preventive measures on the active cases, to show that the current wave of infections is consistent with a single transmission rate. This suggests that the new SARS-CoV-2 variant is as transmissible as previous strains. Our findings indicate that the relaxation of preventive measures is closely related with the ongoing surge in cases. We simulate the effects of new restrictions and vaccination campaigns in 2021, demonstrating that lockdown policies are not fully effective to flatten the curve. For effective mitigation, it is critical that the public keeps on high alert until vaccination reaches a critical threshold.

Understanding soaring coronavirus cases and the effect of contagion policies in the UK

Background: The possibility of 2019 novel coronavirus disease (COVID-19) transmission to neonates through breast milk remains unverified Methods: This paper presents the interim results of a longitudinal study being carried out in Hubei province As of 1 April 2020, 24 mothers confirmed with COVID-19, 19 mothers suspected with COVID-19 but Polymerase chain reaction negative, and 21 mothers without COVID-19 and their neonates have been recruited Telephone follow-up was conducted to collect information on breastfeeding practices Forty-four breast milk samples were collected from 16 of the 24 mothers with confirmed COVID-19 for the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) ribonucleic acid (RNA) and antibodies (IgM and IgG) testing Findings: The average mother-child separation time was 36*7 +/- 21*1 days among mothers confirmed with COVID-19, significantly longer than that of the suspected group (16*6 +/- 13*1 days) and control group (10*5 +/- 8*2 days) Both the COVID-19 confirmed (58*3%) and suspected (52*6%) groups presented significantly lower rates of breastfeeding as compared with the control group (95*2%) All 44 breast milk samples tested negative for the SARS-CoV-2 nucleic acid Thirty-eight breast milk samples underwent antibody testing and all tested negative for IgG Twenty-one breast milk samples from 8 women tested positive for IgM, while the remaining samples from 11 women tested negative Interpretation: Considering the lack of evidence for SARS-CoV-2 transmission through breast milk, breastfeeding counselling along with appropriate hand hygiene precautions and facemasks should be provided to all pregnant women Funding: The study was funded by the Hong Kong Committee for UNICEF

A study of breastfeeding practices, SARS-CoV-2 and its antibodies in the breast milk of mothers confirmed with COVID-19

The COVID-19 lockdowns have created a significant socioeconomic impact on our society. In this paper, we propose a population vaccination game framework, called EPROACH, to design policies for reopenings that guarantee post-opening public health safety. In our framework, a population of players decides whether to vaccinate or not based on the public and private information they receive. The reopening is captured by the switching of the game state. The insights obtained from our framework include the appropriate vaccination coverage threshold for safe-reopening and information-based methods to incentivize individual vaccination decisions. In particular, our framework bridges the modeling of the strategic behaviors of the populations and the spreading of infectious diseases. This integration enables finding the threshold which guarantees a disease-free epidemic steady state under the population's Nash equilibrium vaccination decisions. The equilibrium vaccination decisions depend on the information received by the agents. It makes the steady-state epidemic severity controllable through information. We find out that the externalities created by reopening lead to the coordination of the rational players in the population and result in a unique Nash equilibrium. We use numerical experiments to corroborate the results and illustrate the design of public information for responsible reopening.

EPROACH: A Population Vaccination Game for Strategic Information Design to Enable Responsible COVID Reopening

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Letter from the Editorial Board for Academy of Educational Leadership Journal

SARS-CoV-2 infection results in a mild-to-moderate disease course in most patients, allowing outpatient self-care and quarantine. However, in approx. 10% of cases a two- or three-phasic critical disease course with starting from day 7 to 10 is observed. To facilitate and plan outpatient care, biomarkers prognosing such worsening at an early stage appear of outmost importance. In this accelerated article, we report on the identification of urinary peptides significantly associated with SARS-CoV-2 infection, and the development of a multi-marker urinary peptide based test, COVID20, that may enable prognosis of critical and fatal outcomes in COVID-19 patients. COVID20 is composed of 20 endogenous peptides mainly derived from various collagen chains that enable differentiating moderate or severe disease from critical state or death with 83% sensitivity at 100% specificity. Based on the performance in this pilot study, testing in a prospective study on 1000 patients has been initiated. This article is protected by copyright. All rights reserved.

Urinary Proteomics Associates with COVID-19 Severity: Pilot Proof-of-Principle Data and Design of a Multicentric Diagnostic Study.

In 2020, clinical studies have opened the way for several new treatment options in rheumatoid arthritis, psoriasis arthritis, spondylarthritis and lupus. However, this year was mainly characterized by the Covid-19 pandemic which had a substantial impact on rheumatology. The initial fear for immune-compromised patients undergoing more severe Covid-19 courses remained without evidence. The same was true for the hype of several rheumatic treatments such as Plaquenil or anti-IL-6 blockade which finally did not show efficacy in prospective trials for Covid-19 pneumonia. On the other side, notably the first confinement had a substantial negative impact on rheumatic patients. Our patients are still struggling with the consequences of prolonged immobilization, lack of physiotherapy, missing consultations and treatment adaption as well as social isolation and depression. Telemedicine and upcoming digital solutions compensated this gap at least partially. The post-Covid syndrome with persisting fibromyalgia-like symptoms potentially will join the spectrum of rheumatic disorders.

[Rheumatology update 2020: the focus was on Covid-19].

OBJECTIVE: This study aimed to determine whether vaccination during pregnancy, prematurity, and staphylococci concentration influenced the presence of B. cereus or staphylococcal enterotoxins (SEs) in raw human milk from healthy mothers. STUDY DESIGN: Human milk samples were collected from 152 healthy women. B. cereus, S. aureus and coagulase-negative staphylococci (CNS) were enumerated using selective agar culture media. The detection of B. cereus spores and SEs were determined using ELISA. RESULTS: CNS and B. cereus concentrations in milk from non-vaccinated mothers were higher than that from mothers vaccinated during pregnancy, but S. aureus did not differ. Prematurity did not affect B. cereus or staphylococci in human milk. S. aureus and CNS concentrations in human milk with the presence of B. cereus were higher than that with the absence of B. cereus. Viable B. cereus was present in 9.2% of raw human milk samples whereas SEs were not detected in any samples. CONCLUSIONS: Vaccination during pregnancy and low concentration of staphylococci could reduce the risk of B. cereus in raw human milk. The screening of B. cereus in raw human milk must be performed before pasteurization to reduce the risk of B. cereus infection in preterm infants.

Impact of vaccination during pregnancy and staphylococci concentration on the presence of Bacillus cereus in raw human milk

Acute traumatic coagulopathy is a complex phenomenon following injury and a main contributor to hemorrhage. It remains a leading cause of preventable death in trauma patients. This phenomenon is initiated by systemic injury to the vascular endothelium that is exacerbated by hypoperfusion, acidosis, and hypothermia and leads to systemic activation of the coagulation cascades and resultant coagulopathy. Many previous studies have focused on endotheliopathy with targeted markers such as syndecan-1, soluble thrombomodulin, and plasma adrenaline as potential culprits for initiation and propagation of this state. However, in more recent studies, hyperadhesive von Willebrand factor (VWF), which is released following endothelial injury, and its cleaving metalloprotease ADAMTS13 have emerged as significant targets of the downstream effect of endothelial breakdown and coagulation dysregulation. Elucidation of the mechanism by which the dysregulated VWF-ADAMTS13 axis leads to endothelial dysfunction and coagulopathy after trauma can help identify new targets for therapy and sites for intervention. Much of what is known mechanistically regarding VWF stems from work done in traumatic brain injury. Following localized brain injury, brain-derived extracellular vesicles are released into circulation where they induce a hypercoagulable state that rapidly turns into consumptive coagulopathy. VWF released from injured endothelial cells binds to these extracellular vesicles to enhance their activity in promoting coagulopathy and increasing endothelial permeability. However, there are numerous gaps in our knowledge of VWF following injury, providing a platform for further investigation.

Role of von Willebrand Factor after Injury: It may do More than we Think.

Bluetongue virus (BTV) is a double‐stranded RNA virus of the Reoviridae family. The VP1 protein of BTV is the viral RNA‐dependent RNA polymerase (RdRp), which is responsible for the replication of the viral genome. Currently there is no structural information available for VP1. By manual alignment of BTV, Reovirus and other viral RdRps we have generated a model for the structure of VP1, the RdRp of BTV. The structure can be divided into three domains: an N‐terminal domain, a C‐terminal domain, and a central polymerase domain. Mutation of the putative catalytic site in the central polymerase domain by site‐directed mutagenesis abrogated in vitro replicase activity. Each of the domains was expressed individually and subsequently partially purified to obtain direct evidence for the location of polymerase activity and the nucleoside triphosphate binding site. The nucleoside triphosphate binding site was located by showing that CTP only bound to the full‐length protein or to the polymerase domain and not to either of the other two domains. None of the domains had catalytic activity when tested individually or in tandem but when all three domains were mixed together the RdRp activity was reconstituted. This is the first report of the reconstitution of a functional viral RdRp in vitro from individual domains. © 2007 Wiley Periodicals, Inc. Biopolymers 86: 83–94, 2007. This article was originally published online as an accepted preprint. The “Published Online” date corresponds to the preprint version. You can request a copy of the preprint by emailing the Biopolymers editorial office at biopolymers@wiley.com

Reconstitution of bluetongue virus polymerase activity from isolated domains based on a three‐dimensional structural model

OBJECTIVE: The aim of the study was to evaluate the effectiveness of palliative care simulations with standardized patients in improving the knowledge, skill performance, and critical thinking of newly hired oncology nurses. METHODS: By convenience sampling, 59 newly hired oncology nurses in 2019 were enrolled as control group and 50 in 2020 as simulation group at a grade-A tertiary cancer hospital. Simulation group accepted theory (3 sessions) and simulation teaching includes three representative scenarios (6 sessions) in palliative care: pain management, special scenario communication, and turn over. Control group accepted traditional theory and skill teaching (9 sessions). Then both groups underwent four weeks clinical practice. The knowledge score was assessed by knowledge questionnaires, skill performance by standardized clinical evaluations, and critical thinking by the California Critical Thinking Disposition Inventory in both groups before and after intervention. The satisfaction of two groups was assessed by the learning satisfaction scale. Analysis of variance was conducted among the two groups by SPSS20.0. A difference was considered significant when P ​< ​0.05. RESULTS: After intervention, the simulation group was significantly greater in knowledge of pain management (t ​= ​−7.560, P ​< ​0.001), and knowledge of special scenario communication (Z ​= ​5.031, P ​< ​0.001), as well as the skill score of turnover (Z ​= ​2.808, P ​= ​0.005) than the control group. The critical-thinking score was also significantly greater in the simulation group (Z ​= ​6.229, P ​< ​0.001). The simulation group had higher satisfaction (Z ​= ​5.144，P ​< ​0.001). CONCLUSIONS: Palliative care simulation with standardized patients can improve newly hired oncology nurses’ knowledge, skill performance, and critical thinking and satisfaction of teaching. It would be an effective strategy to train newly hired oncology nurses.

Effectiveness of palliative care simulation in newly hired oncology nurses’ training

Oil and gas, in today's world of diminishing demand and price will not be able to save the finances of the state and, even worse, Sonatrach itself appears to be about to go through yet another corruption scandal, this time involving the appointment of Yamina Hakkar, the wife of the state company's chief executive officer, Toufik Hakkar, as head of the health, safety and environment department of the company Tunisia The role of the state in the other two major countries of the Maghrib has been rather more problematic than has been the case recently in Algeria and Morocco Since the beginning of 2021, the states of the Maghrib have sought to reassert themselves and to increasingly challenge popular resentment despite the severe challenges they face in doing so For the present, though, Morocco has intensified its campaign to win over other states to accept its sovereignty over the Western Sahara, especially now that the Trump administration, in its dying days, had endorsed its claim, apparently in return for Morocco's willingness to join the Abraham Accord and renew diplomatic relations with Israel - a development which the new Biden administration seems unlikely to reverse (Joffé [3]) [Extracted from the article] Copyright of Journal of North African Studies is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Back to the future

Virtual conferences rapidly became the norm during the COVID-19 pandemic. Although necessary, there are shortfalls to strictly virtual meetings, including less enthusiasm for submitting abstracts. An approach that combines in-person attendance and virtual platforms may be an optimal compromise both during the ongoing pandemic and moving forward.

Virtual Conferences and the COVID-19 Pandemic: Are We Missing Out with an Online Only Platform?

We read the recently published article by Drs. Agopian, Verna and Goldberg (1) with great interest. The authors have provided an important assessment of liver transplant volumes across the United Network for Organ Sharing (UNOS) regions from February to March of 2019 and 2020. The study revealed a significant center‐based difference in volume of transplant particularly among centers located in the same metropolitan areas including New York City.

COVID‐19 Infection in Early Post‐Operative Period after Liver Transplantation

BACKGROUND AND AIM A current drawback of endoscopic submucosal dissection (ESD) for early-stage gastrointestinal tumors is the lack of instruments that can safely assist with this procedure. We have developed a pulsed jet device that can be incorporated into a gastrointestinal endoscope. Here, we investigated the mechanical profile of the pulsed jet device and demonstrated the usefulness of this instrument in esophageal ESD in swine. METHODS The device comprises a 5-Fr catheter, a 14-mm long stainless steel tube for generating the pulsed water jet, a nozzle and an optical quartz fiber. The pulsed water jet was generated at pulse rates of 3 Hz by irradiating the physiological saline (4°C) within the stainless steel tube with an holmium-doped yttrium-aluminum-garnet (Ho:YAG) laser at 1.1 J/pulse. Mechanical characteristics were evaluated using a force meter. The device was used only for the part of submucosal dissection in the swine ESD model. Tissues removed using the pulsed jet device and a conventional electrocautery device, and the esophagus, were histologically examined to assess thermal damage. RESULTS The peak impact force was observed at a stand-off distance of 40 mm (1.1 J/pulse). ESD using the pulsed jet device was successful, as the tissue specimens showed precise dissection of the submucosal layer. The extent of thermal injury was significantly lower in the dissected bed using the pulsed jet device. CONCLUSION The results showed that the present endoscopic pulsed jet system is a useful alternative for a safe ESD with minimum tissue injury.

Experimental application of pulsed laser-induced water jet for endoscopic submucosal dissection: mechanical investigation and preliminary experiment in swine.

BACKGROUND AND AIMS: The novel coronavirus disease 2019 (COVID-19) has rapidly spread through the whole globe. Since the beginning of the outbreak, some individuals were more likely to manifest more severe outcomes. Diabetic patients were of that sort; however, the severity of COVID-19 in prediabetic ones remained less identified. This study aimed to systematically review and conduct a meta-analysis of the previously published observational studies investigating the severity of COVID-19 in prediabetic patients. METHODS: Medline/PubMed, Scopus, EMBASE, Web of Science, Cochrane library, and google scholar databases were queried to identify relevant studies concerning prediabetes and serious COVID-19 outcomes. The Newcastle-Ottawa scale was used to assess the quality of the included studies. Odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the likelihood of severe presentations in prediabetic patients. RESULTS: A total of 3027 patients were included in the meta-analysis. A random-effects model was used regarding the high heterogeneity (I(2) = 55%). Prediabetes was significantly associated with adverse outcomes of COVID-19 with an OR of 2.58 (95%CI, 1.46–4.56). CONCLUSION: Prediabetes could act as a risk factor for the severity of COVID-19. Early detection of prediabetic patients might be helpful to adopt preventive and protective strategies to improve the prognosis of the infected individuals.

Prediabetes and COVID-19 severity, an underestimated risk factor: A systematic review and meta-analysis

AIMS : To chart the effect of the COVID-19 pandemic on the activity of interventional electrophysiology services in affected regions. METHODS AND RESULTS : We reviewed the electrophysiology laboratory records in three affected cities: Wenzhou in China, Milan in Italy, and London in the UK. We inspected catheter lab records and interviewed electrophysiologists in each centre to gather information on the impact of the pandemic on working patterns and on the health of staff members and patients. There was a striking decline in interventional electrophysiology activity in each of the centres. The decline occurred within a week of the recognition of widespread community transmission of the virus in each region and shows a striking correlation with the national figures for new diagnoses of COVID-19 in each case. During the period of restriction, workflow dropped to <5% of normal, consisting of emergency cases only. In two of three centres, electrophysiologists were redeployed to perform emergency work outside electrophysiology. Among the centres studied, only Wenzhou has seen a recovery from the restrictions in activity. Following an intense nationwide programme of public health interventions, local transmission of COVID-19 ceased to be detectable after 18 February allowing the electrophysiology service to resume with a strict testing regime for all patients. CONCLUSION : Interventional electrophysiology is vulnerable to closure in times of great social difficulty including the COVID-19 pandemic. Intense public health intervention can permit suppression of local disease transmission allowing resumption of some normal activity with stringent precautions.

Electrophysiology in the time of coronavirus: coping with the great wave

This preprint further characterizes a superantigen motif identified in SARS-CoV-2 spike protein and evaluates a monoclonal antibody targeting this region that can neutralize live virus.

Super(antigen) target for SARS-CoV-2

This survey study examines the attitudes and beliefs associated with receipt of the COVID-19 vaccination during pregnancy among pregnant people.

Attitudes and Beliefs Associated With COVID-19 Vaccination During Pregnancy

In the past, most researchers have explained the three-stage creep behavior of asphalt mixture in detail. Still, there is no reasonable model to describe the creep of the consolidation effect. To accurately describe the consolidation effect of an asphalt mixture during the viscoelastic deformation process, a modified time hardening model was established by using the Malthus model and the Logistic function to change its creep strain and creep compliance. According to the characteristics of asphalt mixture creep, a single penetration creep test was conducted for high-elasticity modified asphalt mixtures at different temperatures (20 °C, 40 °C, 60 °C) and various loading levels (0.55 MPa, 0.70 MPa, 0.85 MPa, 1.00 MPa). The test results showed that the effect of stress on deformation within the normal range of variation was more significant than that of temperature. In addition, the test results were simulated by the modified time hardening model using surface fitting and compared with a time hardening model and a modified Burgers model. A fitting analysis showed that the modified time hardening model more accurately represents the asphalt mixture's consolidation effect and creep behavior. Therefore, the modified time hardening model can better show the consolidation effect in the creep process.

Study of a Modified Time Hardening Model for the Creep Consolidation Effect of Asphalt Mixtures

The Sputnik V COVID-19 vaccine is a member of the so-called vector vaccines and uses two different vectors (Ad26 priming and Ad5 boost) to reduce the risk of a reduction in the effectiveness of the vaccination. Real life data indicate an efficacy of the vaccine above 97%. Low cost and no need for ultra-cold storage temperature temperatures are other pluses of the Sputnik V vaccine. However, there are also several important shortcomings that must be considered such as the possible reduction of its immunogenicity in the presence of very high Ad5 neutralizing antibody titres and the decrease with age of the antibody titres neutralizing the virus. Furthermore, there is emerging documentation that Sputnik V has a reduced neutralizing capacity against the Beta variant and all variants with the spike protein carrying the E484K substitution. Nevertheless, due to its characteristics, Sputnik V could be another useful means of satisfying the need for mass vaccination. However, it is imperative to document the efficacy and safety of the Sputnik V vaccine in individuals with high pre-existing anti-Ad26 and Ad5-neutralizing antibody titres and in those under the age of 18 or older than 60 years and be certain that Sputnik V does not cause the rare development of immune thrombotic thrombocytopenia. It is hoped that the now widespread use of this vaccine will generate a large pragmatic real-world study with data accessible to anyone interested in verifying them.

Controversy surrounding the Sputnik V vaccine

The potential of nucleic acid therapeutics to treat diseases by targeting specific cells has resulted in its increasing number of uses in clinical settings. However, the major challenge is to deliver bio-macromolecules into target cells and/or subcellular locations of interest ahead in the development of delivery systems. Although, supercharged residues replaced protein 36 + GFP can facilitate itself and cargoes delivery, its efficiency is still limited. Therefore, we combined our recent progress to further improve 36 + GFP based delivery efficiency. We found that the penetration efficacy of 36 + GFP protein was significantly improved by fusion with CPP-Dot1l or treatment with penetration enhancer dimethyl sulfoxide (DMSO) in vitro. After safely packaged with plasmid DNA, we found that the efficacy of in vitro and in vivo transfection mediated by 36 + GFP-Dot1l fusion protein is also significantly improved than 36 + GFP itself. Our findings illustrated that fusion with CPP-Dot1l or incubation with DMSO is an alternative way to synergically promote 36 + GFP mediated plasmid DNA delivery in vitro and in vivo.

Improved transfer efficiency of supercharged 36 + GFP protein mediate nucleic acid delivery

BACKGROUND Bariatric surgery outcomes have been examined in Germany since January 1, 2005. All data were registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg. METHODS The data were collected from an online data bank. Data collection began in 2005 for gastric banding (GB) and Roux-en-Y gastric bypass (RYGB) results. In addition to primary bariatric operations, data regarding the complications of revision procedures and redo operations were analyzed. Participation in the quality assurance study was required for all certified centers in Germany. RESULTS RYGBs are a popular redo operation after failed gastric banding. In the German Bariatric Surgery Registry (GBSR), we analyzed data from 263 RYGB operations that used a one-step approach after GB and 116 operations that used a two-step approach. The leakage rates for primary RYGB decreased to 1.8%. The incidence of leakage after a one-step RYGB after GB was lower (1.9%) than after the two-step procedure (2.6%). CONCLUSION RYGBs are popular procedures after failed GB in Germany. The multivariable analysis for overall intraoperative complications revealed a significant difference between the two-step and the one-step procedure. In an unadjusted and multivariate assessment, the one-step procedure had statistically lower general postoperative complications than the two-step approach. Therefore, we suggest performing band removal and RYGB as a one-step procedure. Further analysis is necessary to evaluate the risk factors for the one-step procedure. Follow-up investigations must be performed to determine whether RYGB is an effective and safe option after GB.

One versus two-step Roux-en-Y gastric bypass after gastric banding—data analysis of the German Bariatric Surgery Registry.

Since the start of the COVID-19 pandemic, nursing home residents have accounted for roughly one of every six COVID-19 deaths in the United States. Nursing homes have also been very dangerous places for workers, with more than one million nursing home workers testing positive for COVID-19 as of April 2022. Labor unions may play an important role in improving workplace safety, with potential benefits for both nursing home workers and residents. We examined whether unions for nursing home staff were associated with lower resident COVID-19 mortality rates and worker COVID-19 infection rates compared with rates in nonunion nursing homes, using proprietary data on nursing home-level union status from the Service Employees International Union for all forty-eight continental US states from June 8, 2020, through March 21, 2021. Using negative binomial regression and adjusting for potential confounders, we found that unions were associated with 10.8 percent lower resident COVID-19 mortality rates, as well as 6.8 percent lower worker COVID-19 infection rates. Substantive results were similar, although sometimes smaller and less precisely estimated, in sensitivity analyses.

Resident Mortality And Worker Infection Rates From COVID-19 Lower In Union Than Nonunion US Nursing Homes, 2020-21

To investigate if there would be increased autonomy and participation in meaningful occupations and positive perception of the program after attending Empower SCI and to investigate whether participation and autonomy improved in individual's daily lives after attending Empower SCI 2-week summer program. A retrospective cohort designed to evaluate participants' experiences from the 2019 (in-person) or 2020 (virtual) Empower SCI program. Community Based Setting on a University Campus both in-person and virtually (due to COVID-19 restrictions). Summer 2019/2020- Participants recruited using convenience sampling from the 2019 cohort attended in person. 2020 cohort attended virtually. A total of 9 participants, 8 from the 2019 cohort 1 from 2020 cohort. The EmpowerSCI is a 2-week summer program of a 2nd chance at rehabilitation. Includes therapies, sports, education and socialization. The Impact on Participation and Autonomy (IPA) Survey was administered and completed via REDcap. Participants were asked to complete survey with the mindset they had "before attending Empower SCI. During December 2020, the IPA was Administered by phone. Participants were asked to complete survey with the mindset they had "after attending Empower SCI" and were asked the face valid qualitative questions developed by the research team over the phone. Researchers imputed data on REDcap. Impact on Participation and Autonomy (IPA) Survey that is made up of 10 sub-scales- aimed at looking at one's independence and ability to complete everyday activities. Some examples include "Mobility and Getting Around", "Self-Care", "Leisure", "Work", "Education" and "Social Relationships". Qualitative Questions Mobility (Mean): 13.1→ 11.1 (p=0.044) Leisure (Mean): 4.8→ 4.3 (p=0.029) Concluding (Mean): 3.2→ 2.6 (p=0.048) Data showed improvement in each subsection (a decrease in IPA scores shows important). Empower SCI led to significant improvements of participation and autonomy in: Mobility, and Leisure on the IPA. Improvements (although not significant) in: Getting around, self-care, work, helping others, managing money, and social participation. Qualitative data showed a positive impact of Empower SCI such as Increased confidence and comfort, more positive mindset, sense of community. N/A.

The Effect of the Empower SCI Program on Improving Occupational Performance for Individuals with Spinal Cord Injury

INTRODUCTION The Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21) took place on 17th June 2021, providing the first assessment of performance against the Society for Acute Medicine's Clinical Quality Indicators (CQIs) within acute medical units since the start of the COVID-19 pandemic. METHODS All acute hospitals in the UK were invited to participate. Data were collected on unit structure, and for patients admitted to acute medicine services over a 24-hour period, with follow-up at 7 days. RESULTS 158 units participated in SAMBA21, from 156 hospitals. 8973 patients were included. The number of admissions per unit had increased compared to SAMBA19 (Sign test p<0.005). An early warning score was recorded within 30 minutes of hospital arrival in 77.4% of patients. 87.4% of unplanned admissions were seen by a tier 1 clinician within 4 hours of arrival. Overall, the medical team performed the initial clinician assessment for 36.4% of unplanned medical admissions. More than a third of medical admissions had their initial assessment in Same Day Emergency Care (SDEC) in 25.4% of hospitals. 62.1% of unplanned admissions were seen by two other clinical decision makers prior to consultant review. Of those unplanned admissions requiring consultant review, 67.8% were seen within the target time. More than a third of unplanned admissions were discharged the same day in 41.8% of units. CONCLUSION Performance against the CQIs for acute medicine was maintained in comparison to previous rounds of SAMBA, despite increased admissions. There remains considerable variation in unit structure and performance within acute medical services.

Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21): assessing national performance of acute medicine services.

BACKGROUND: The United States now has the highest death toll due to COVID-19. Many otolaryngology procedures, including laryngoscopy, bronchoscopy, and esophagoscopy, place otolaryngologists at increased risk of coronavirus transmission due to close contact with respiratory droplets and aerosolization from the procedure. The aim of this study is to provide an overview of guidelines on how to perform these procedures during the coronavirus pandemic. METHODS: Literature review was performed. Articles citing laryngoscopy, bronchoscopy, esophagoscopy use with regard to COVID-19 were included. RESULTS: Laryngoscopy, bronchoscopy, and esophagoscopy are all used in both emergent and elective situations. Understanding the risk stratification of cases and the varied necessity of personal protective equipment is important in protecting patients and health care workers. CONCLUSIONS: Summary guidelines based on the literature available at this time are presented in order to decrease transmission of the virus and protect those involved.

Bronchoscopy, laryngoscopy, and esophagoscopy during the COVID-19 pandemic

BACKGROUND: Universal screening has been proposed as a strategy to identify asymptomatic individuals infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and mitigate transmission. AIM: To investigate the rate of positive tests among pregnant women in Melbourne, Australia. METHODS: We performed a cross-sectional prevalence study at three maternity hospitals (one tertiary referral hospital and two secondary maternities) in Melbourne, Australia. SARS-CoV-2 testing was offered to all pregnant women attending face-to-face antenatal visits and to those attending the hospital with symptoms of possible coronavirus disease, between 6th and 19th of May 2020. Testing was performed by multiplex-tandem polymerase chain reaction (PCR) on combined oropharyngeal and nasopharyngeal swabs. The primary outcome was the proportion of positive SARS-CoV-2 tests. FINDINGS: SARS-CoV-2 testing was performed in 350 women, of whom 19 had symptoms of possible COVID-19. The median maternal age was 32 years (IQR 28-35 years), and the median gestational age at testing was 33 weeks and four days (IQR 28 weeks to 36 weeks and two days). All 350 tests returned negative results (p̂=0%, 95% CI 0-1.0%). CONCLUSION: In a two-week period of low disease prevalence, the rate of asymptomatic coronavirus infection among pregnant women in Australia during the study period was negligible, reflecting low levels of community transmission.

Coronavirus testing in women attending antenatal care

OBJECTIVE To investigate the clinical effect of treating mallet finger deformity using a modified palmaris longus tendon graft through a bone tunnel. METHODS Altogether, 21 patients with mallet finger deformity (16 men, 5 women; average age 31 years, range 19-47 years) were treated with a modified palmaris longus tendon graft through a bone tunnel during 18 months (2014-2016). Four index fingers, seven middle fingers, eight ring fingers, and two little fingers were treated for four cutting injuries, eleven finger sprains, four crush injuries, and two twist injuries (7 open and 14 closed injuries). Duration from injury to surgery was 9 h to 13 weeks. Three patients underwent surgery after 6 weeks of unsuccessful conservative treatment. No tendon was attached to the extensor tendon insertion in 16 patients, and 5 had residual tendon of <0.2 cm attached. All patients had distal segment flexion deformity and dorsiflexion disorder. Surgery comprised transverse penetration and vertical drilling of the base of the distal phalanx (2.0 and 2.5 mm diameter drills). Equal shallow semitendinosus pieces of the palmaris longus tendon (4 cm) were obtained from the sagittal end and were passed through a dorsal bone hole, emerging from a transverse bone hole. The two bundles were sutured to the main tendon. Tension was adjusted, and the broken ends were sutured. The distal interphalangeal joints were fixed in hyperextension. RESULTS All patients were followed for 7-16 months (average 6.0 ± 0.3 months) postoperatively. All 21 patients had grade A wound healing, with no complications (e.g., necrotic wound, recurrence, joint stiffness). The mallet finger deformity was corrected with good appearance, no obvious abnormalities, and satisfactory flexion and extension. Two patients had a superficial wound infection. Each recovered after symptomatic treatment. One patient had a mild result, with limited extension. There were no recurrences. Results were evaluated according to Patel et al.'s system, which revealed 15 excellent and 5 good results (combined 95.23% rate), with 1 mild result (limited extension). Patients were satisfied with the appearance and function of the affected fingers, and the desired surgical end result was achieved. CONCLUSION Use of this modified surgery for treating mallet finger deformity, especially with no or little tendon attached at the extensor tendon insertion, results in nearly anatomical reconstruction of the extensor tendon insertion. Its advantages include simple surgery, reliable fixation, fewer complications, and clinical efficacy.

Treatment of mallet finger deformity with a modified palmaris longus tendon graft through a bone tunnel.

The world is now faced with a devastating pandemic outbreak, COVID-19. The latest coronavirus infected almost all continents and witnessed sharp rises in cases diagnosed. The engineers tend to eliminate the matter and have solutions, one in every utilizing technical innovation. Researchers from Singapore, Taiwan, and Denmark have developed a fully automated robot that may take coronavirus swabs in order for health care professionals don't seem to be exposed to the chance of infection. The objective of this study is to present the potential effects of robotics to help healthcare professionals on getting specimens and testing for COVID-19. These possible consequences include positive and negative outcomes and as a result, the overall impact on the profit or loss to society is far from obvious. The paper discusses two theoretical scenarios, distinguished fundamentally by the different behavioral responses of the automated swab robot and the selection of results in line with policy interventions. © 2021 Institute of Advanced Engineering and Science. All rights reserved.

The effect of automated swab robot: new technology drives new behavior

Medicine has around 450 academic foundation roles available every year involving research and teaching, leadership and management, or quality improvement. However, an academic career in dentistry is not as clearly defined immediately post-graduation. The North East General Professional Training scheme is a two-year longitudinal dental foundation training scheme and this year, for the first time, has conducted a pilot programme allowing two trainees the opportunity to complete a research project. The experiences of the two trainees confirm the benefit of dental foundation research posts and support the need for additional positions nationally.

Do I consider a career in dental academia and if so how do I go about it?

PURPOSE OF REVIEW: As the coronavirus disease 2019 (COVID-19) pandemic continues to surge, determining the safety and timing of proceeding with solid organ transplantation (SOT) in transplant candidates who have recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and who are otherwise transplant eligible is an important concern. We reviewed the current status of protocols and the outcomes of SOT in SARS-CoV-2 recovered patients. RECENT FINDINGS: We identified 44 published reports up through 7 September 2021, comprising 183 SOT [kidney = 115; lung = 27; liver = 36; heart = 3; simultaneous pancreas-kidney (SPK) = 1, small bowel = 1] transplants in SARS-CoV-2 recovered patients. The majority of these were living donor transplants. A positive SARS-CoV-2 antibody test, although not obligatory in most reports, was a useful tool to strengthen the decision to proceed with transplant. Two consecutive real-time polymerase chain test (RT-PCR) negative tests was one of the main prerequisites for transplant in many reports. However, some reports suggest that life-saving transplantation can proceed in select circumstances without waiting for a negative RT-PCR. In general, the standard immunosuppression regimen was not changed. SUMMARY: In select cases, SOT in COVID-19 recovered patients appears successful in short-term follow-up. Emergency SOT can be performed with active SARS-CoV-2 infection in some cases. In general, continuing standard immunosuppression regimen may be reasonable, except in cases of inadvertent transplantation with active SARS-CoV-2. Available reports are predominantly in kidney transplant recipients, and more data for other organ transplants are needed.

Solid Organ Transplantation in SARS-CoV-2 Recovered Transplant Candidates: a Comprehensive Review of Recent Literature

Neural networks often require large amounts of expert annotated data to train. When changes are made in the process of medical imaging, trained networks may not perform as well, and obtaining large amounts of expert annotations for each change in the imaging process can be time consuming and expensive. Online unsupervised learning is a method that has been proposed to deal with situations where there is a domain shift in incoming data, and a lack of annotations. The aim of this study is to see whether online unsupervised learning can help COVID-19 CT scan classification models adjust to slight domain shifts, when there are no annotations available for the new data. A total of six experiments are performed using three test datasets with differing amounts of domain shift. These experiments compare the performance of the online unsupervised learning strategy to a baseline, as well as comparing how the strategy performs on different domain shifts. Code for online unsupervised learning can be found at this link: https://github.com/Mewtwo/online-unsupervised-learning

Online unsupervised Learning for domain shift in COVID-19 CT scan datasets

BACKGROUND: As the coronavirus disease 2019 (COVID-19) pandemic is ongoing, heavy workload of healthcare workers (HCWs) is a concern. This study investigated the workload of HCWs responding to the COVID-19 outbreak in South Korea. METHODS: A nationwide cross-sectional survey was conducted from September 16 to October 15, 2020, involving 16 healthcare facilities (4 public medical centers, 12 tertiary-care hospitals) that provide treatment for COVID-19 patients. RESULTS: Public medical centers provided the majority (69.4%) of total hospital beds for COVID-19 patients (n = 611), on the other hand, tertiary care hospitals provided the majority (78.9%) of critical care beds (n = 57). The number of beds per doctor (median [IQR]) in public medical centers was higher than in tertiary care hospitals (20.2 [13.0, 29.4] versus 3.0 [1.3, 6.6], P = 0.006). Infectious Diseases physicians are mostly (80%) involved among attending physicians. The number of nurses per patient (median [interquartile range, IQR]) in tertiary-care hospitals was higher than in public medical centers (4.6 [3.4–5] vs. 1.1 [0.8–2.1], P = 0.089). The median number of nurses per patient for COVID-19 patients was higher than the highest national standard in South Korea (3.8 vs. 2 for critical care). All participating healthcare facilities were also operating screening centers, for which a median of 2 doctors, 5 nurses, and 2 administrating staff were necessary. CONCLUSION: As the severity of COVID-19 patients increases, the number of HCWs required increases. Because the workload of HCWs responding to the COVID-19 outbreak is much greater than other situations, a workforce management plan regarding this perspective is required to prevent burnout of HCWs.

Workload of Healthcare Workers During the COVID-19 Outbreak in Korea: A Nationwide Survey

An understanding of the pathological inflammatory mechanisms involved in SARS-CoV-2 virus infection is necessary in order to discover new molecular pharmacological targets for SARS-CoV-2 cytokine storm. In this study, the effects of a recombinant SARS-CoV-2 spike glycoprotein S1 was investigated in human peripheral blood mononuclear cells (PBMCs). Stimulation of PBMCs with spike glycoprotein S1 (100 ng/mL) resulted in significant elevation in the production of TNF&#945;, IL-6, IL-1ß and IL-8. However, pre-treatment with dexamethasone (100 nM) caused significant reduction in the release of these cytokines. Further experiments revealed that S1 stimulation of PBMCs increased phosphorylation of NF-&#954;B p65 and I&#954;B&#945;, and I&#954;B&#945; degradation. DNA binding of NF-&#954;B p65 was also significantly increased following stimulation with spike glycoprotein S1. Treatment of PBMCs with dexamethasone (100 nM) or BAY11-7082 (1 µM) resulted in inhibition of spike glycoprotein S1-induced NF-&#954;B activation. Activation of p38 MAPK by S1 was blocked in the presence of dexamethasone and SKF 86002. CRID3, but not dexamethasone pre-treatment, produced significant inhibition of S1-induced activation of NLRP3/caspase-1. Further experiments revealed that S1-induced increase in the production of TNF&#945;, IL-6, IL-1ß and IL-8 was reduced in the presence of BAY11-7082 and SKF 86002, while CRID3 pre-treatment resulted in the reduction of IL-1ß production. These results suggest that SARS-CoV-2 spike glycoprotein S1 stimulated PBMCs to release pro-inflammatory cytokines through mechanisms involving activation of NF-&#954;B, p38 MAPK and NLRP3 inflammasome. It is proposed that the clinical benefits of dexamethasone in COVID-19 are possibly due to its anti-inflammatory activity in reducing SARS-CoV-2 cytokine storm.

Induction of Exaggerated Cytokine Production in Human Peripheral Blood Mononuclear Cells by a Recombinant SARS-CoV-2 Spike Glycoprotein S1 and Its Inhibition by Dexamethasone

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has started in December 2019 and still ongoing. The disease has been expanding rapidly with a high variety of phenotypes from asymptomatic, mild respiratory tract infection, multiple organ system dysfunction, and death. Neurological manifestations also appear in patients with COVID-19, such as headache, seizures, a decrease of consciousness, and paralysis. The hypercoagulable state in patients with COVID-19 is associated with the thromboembolic incident including ischemic strokes, venous thromboembolism, pulmonary artery embolism, and many further. Cerebral sinus venous thrombosis (CSVT) is a rare neurovascular emergency that is often found in critically ill patients. We report two cases of CSVT with different onsets, neurologic manifestations, and prognoses. CASE PRESENTATION: Two cases of cerebral sinus venous thrombosis in COVID-19 patients were reported, following respiratory, hematology, and coagulation disarrangements, which was triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The first patient, which was presented with a seizure, had hypertension and diabetes mellitus as comorbidities. The latter case had no comorbidity but showed more severe presentations of COVID-19 such as brain and lung thrombosis, although already had several days of intravenous anticoagulant administrations. These two cases also have a different course of disease and outcomes, which were interesting topics to study. CONCLUSIONS: CSVT is one of the neurological complications of the COVID-19 when the brainstem venous drainage is involved. Despite successful alteration to the negative result of SARS-CoV-2 through the rt-PCR test, thrombogenesis and coagulation cascade continuing. Therefore, a high level of neutrophil to lymphocyte ratio (NLR), D-dimer, fibrinogen, and C-reactive protein (CRP) are paramount indicators of poor prognosis.

Case reports of cerebral sinus venous thrombosis in COVID-19 patients

PURPOSE OF REVIEW: In order to inform patients of their genetic risks, access to the medical records and/or stored samples of their relatives is often helpful. We consider some of the obstacles to such access when these relatives are deceased and suggest how they might be navigated. RECENT FINDINGS: We explore an issue first highlighted in 2004 by Lucassen et al. (Br Med J 328:952–953, 2004) and re-evaluate it in the wake of novel technologies and mainstreaming of genomic medicine. We find that it is still an issue in practice despite professional guidelines advocating access to familial information (Joint Committee on Genomics in Medicine 2019) and that the Human Tissue Act 2004 is often wrongly constructed as a reason to block access. Access is often obstructed by failing to adopt the necessary relational concept of autonomy that applies in genetic medicine as reported by Horton and Lucassen (Curr Genet Med Rep 7:85–91, 2019) and by considering confidentiality to be absolute, even after death. In response to a recent legal case about the confidentiality of genetic test results, and their disclosure to family members (ABC v St George’s Healthcare NHS Trust 2020), Dove et al. (J Med Ethics 45:504–507, 2019) suggested that a duty to consider the interests of genetic relatives could co-exist alongside a duty of confidentiality to a patient. In this way, healthcare professionals can use professional judgement about the relative value of genetic information to family members. This is equally relevant in accessing deceased relatives’ information. A recent systematic review found a high level of acceptability of postmortem use of genetic data for medical research amongst participants and their relatives, and it is reasonable to assume that this acceptability would extend to clinical practice as reported by Bak et al. (Eur J Hum Genet 28:403–416, 2020). SUMMARY: Within clinical practice, access to medical records/samples of deceased relatives is often obstructed unnecessarily, potentially resulting in harm to the living relatives seeking advice. Consent to such access is important but need not be the bureaucratic hurdle that is often imposed.

From Beyond the Grave: Use of Medical Information from the Deceased to Guide Care of Living Relatives

The current coronavirus disease 2019 (COVID-19) pandemic has raised concerns about the safety of laboratory personnel who handle tissue samples that harbor pathogens, including those performing autopsies. While pathologists have performed autopsies on infected decedents for centuries, universal precaution protocols for limiting exposure to pathogens were not developed until the 20th century. This article reviews the history and effectiveness of universal precautions, with an emphasis on performing autopsies on COVID-19 decedents.

Universal Precautions Provide Appropriate Protection during Autopsies of Patients with Infectious Diseases

The development of rapid and ultra-sensitive detection technology of SARS-CoV-2 RNA for shortening the diagnostic window and achieving early detection of virus infections is a huge challenge to the efficient prevention and control of COVID-19. Herein, a novel ultra-sensitive surface-enhanced Raman spectroscopy (SERS) sensor powered by non-enzymatic signal amplification is proposed for rapid and reliable assay of SARS-CoV-2 RNA based on SERS-active silver nanorods (AgNRs) sensing chips and a specially designed smart unlocking-mediated target recycling signal amplification strategy. The SERS sensing was carried out by a one-pot hybridization of the lock probes (LPs), hairpin DNAs and SERS tags with SARS-CoV-2 RNA samples on an arrayed SERS sensing chip to achieve the recognition of SARS-CoV-2 RNA, the execution of nuclease-free unlocking-mediated target recycling signal amplification, and the combination of SERS tags to generate SERS signal. The SERS sensor for SARS-CoV-2 RNA can be achieved within 50 min with an ultra-high sensitivity low to 51.38 copies/mL, and has good selectivity in discriminating SARS-CoV-2 RNA against other respiratory viruses in representative clinical samples, which is well adapted for rapid, ultra-sensitive, multi-channel and point-of-care testing of viral nucleic acids, and is expected to achieve detection of SARS-CoV-2 infection in earlier detection windows for efficient COVID-19 prevention and control.

Non-enzymatic signal amplification-powered point-of-care SERS sensor for rapid and ultra-sensitive assay of SARS-CoV-2 RNA

Purpose This study aims to understand how knowledge workers working from home during COVID-19 changed their views on physical work environments and working-from-home practices. Design/methodology/approach This study conducted a survey targeting workers in the USA recruited via Amazon Mechanical Turk. A total of 1,651 responses were collected and 648 responses were used for the analysis. Findings The perceived work-life balance improved during the pandemic compared to before, while the balance of physical boundaries between the workplace and home decreased. Workplace flexibility, environmental conditions of home offices and organizational supports are positively associated with productivity, satisfaction with working from home and work-life balance during the pandemic. Research limitations/implications While the strict traditional view of "showing" up in the office from Monday through Friday is likely on the decline, the hybrid workplace with flexibility can be introduced as some activities are not significantly affected by the work location, either at home-based or corporate offices. The results of this study also highlight the importance of organizations to support productivity and satisfaction in the corporate office as well as home. With the industry collaboration, future research of relatively large sample sizes and study sites, investigating workers' needs and adapted patterns of use in home-based and corporate offices, will help corporate real estate managers make decisions and provide some level of standardization of spatial efficiency and configurations of corporate offices as well as essential supports for home offices. Originality/value The pandemic-enforced working-from-home practices awaken the interdependence between corporate and home environments, how works are done and consequently, the role of the physical workplace. This study built a more in-depth understanding of how workers who were able to continue working from home during COVID-19 changed or not changed their views on physical work environments and working-from-home practices.

Does working from home work? Experience of working from home and the value of hybrid workplace post-COVID-19

Cancer patients are regarded as highly vulnerable to SARS-CoV-2. However, little is known regarding how cancer treatments should be restarted for cancer patients after COVID-19. We herein report a pancreatic cancer case in which chemotherapy was able to be reinstituted after COVID-19. The patient was a 67-year-old man diagnosed with pancreatic cancer. On day 7 after first chemotherapy, he was infected with COVID-19. A SARS-CoV-2 test was negative after one month of treatment, and we reinstituted chemotherapy. The patient has received three cycles of chemotherapy without recurrence of COVID-19. It may be feasible to reinstitute chemotherapy for cancer patients after a negative SARS-CoV-2 test.

Successful and Safe Reinstitution of Chemotherapy for Pancreatic Cancer after COVID-19

BACKGROUND: The role of extracorporeal membrane oxygenation (ECMO) in the management of critically ill COVID‐19 patients remains unclear. Our study aims to analyze the outcomes and risk factors from patients treated with ECMO. METHODS AND RESULTS: This retrospective, single‐center study includes 17 COVID‐19 patients treated with ECMO. Univariate and multivariate parametric survival regression identified predictors of survival. Nine patients (53%) were successfully weaned from ECMO and discharged. The incidence of in‐hospital mortality was 47%. In a univariate analysis, only four out of 83 pre‐ECMO variables were significantly different; IL‐6, PCT, and NT‐proBNP were significantly higher in non‐survivors than in survivors. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score was significantly higher in survivors. After a multivariate parametric survival regression, IL‐6, NT‐proBNP and RESP scores remained significant independent predictors, with hazard ratios (HR) of 1.069 [95%‐CI: 0.986‐1.160], p= 0.016 1.001 [95%‐CI: 1.000‐1.001], p=0.012; and 0.843 [95%‐CI: 0.564‐1.260], p=0.040, respectively. A prediction model comprising IL‐6, NT‐proBNP, and RESP score showed an area under the curve (AUC) of 0.87, with a sensitivity of 87.5% and 77.8% specificity compared to an AUC of 0.79 for the RESP score alone. CONCLUSION: The present study suggests that ECMO is a potentially lifesaving treatment for selected critically ill COVID‐19 patients. Considering IL‐6 and NT‐per‐BNP, in addition to the RESP score, may enhance outcome predictions.

Role of Extracorporeal Membrane Oxygenation in Critically Ill COVID‐19 Patients and Predictors of Mortality

The efficacy of the anti-inflammatory drug Bobel-24 against experimental infection by Cryptosporidium parvum was evaluated in neonatal lambs. The animals were treated by oral administration of the drug at 50 or 500 mg/kg of body weight. The prophylactic/therapeutic treatment was started 4 h before inoculation of the lambs with oocysts and was continued for eight consecutive days. The therapeutic treatment was initiated at the onset of diarrhoea, after confirmation of infection, and was continued for six consecutive days. Infection was monitored by daily examination of faecal samples from the first day until 30 days post-inoculation. The criteria considered in evaluating development of the infection and the drug activity were: oocyst shedding, presence of diarrhoea and weight gain at 15 and 30 days post-inoculation. Bobel-24 was effective as a prophylactic/therapeutic treatment at the lowest dose (50 mg/kg of body weight); in the group treated with this dose of drug there was a longer prepatent period, a shorter patent period and a lower intensity of oocyst excretion than in the untreated control group, and the differences were all statistically significant (P < 0.05). Moreover, one animal did not excrete oocysts, and two lambs had diarrhoea, for only 1 and 2 days. In the group treated with the higher dose of the drug, the diarrhoea lasted for a significantly shorter period (P < 0.05) than in the untreated group.

Activity of an anti-inflammatory drug against cryptosporidiosis in neonatal lambs

BACKGROUND: Extensive sequencing efforts have been taking place for the Atlantic cod (Gadus morhua) in recent years, the number of ESTs in the Genbank has reached more than 140.000. Despite its importance in North Atlantic fisheries and potential use in aquaculture, relatively few gene expression examination exists for this species, and systematic evaluations of reference gene stability in quantitative real-time RT-PCR (qRT-PCR) studies are lacking. RESULTS: The stability of 10 potential reference genes was examined in six tissues of Atlantic cod obtained from four populations, to determine the most suitable genes to be used in qRT-PCR analyses. Relative transcription levels of genes encoding β-actin (ACTB), elongation factor 1A (EF1A), actin-related protein-2 (ARP-2), glyceraldehyde-3P-dehydrogenase (GAPDH), ubiquitin (Ubi), acidic ribosomal protein (ARP), ribosomal protein S9 (S9), ribosomal protein L4 (RPL4), RPL22 and RPL37 were quantified in gills, brain, liver, head kidney, muscle and middle intestine in six juvenile fish from three wild populations and from farmed Atlantic cod. Reference gene stability was investigated using the geNorm and NormFinder tools. Based on calculations performed with the geNorm, which determines the most stable genes from a set of tested genes in a given cDNA sample, ARP, Ubi, S9 and RPL37 were among the most stable genes in all tissues. When the same calculations were done with NormFinder, the same genes plus RPL4 and EF1A were ranked as the preferable genes. CONCLUSION: Overall, this work suggests that the Ubi and ARP can be useful as reference genes in qRT-PCR examination of gene expression studying wild populations of Atlantic cod.

Selection of reference genes for qRT-PCR examination of wild populations of Atlantic cod Gadus morhua

This chapter examines new challenges to the politeness dimension of civility presented by COVID-19. First, the pandemic has made it more difficult for people to identify norms of politeness and behave appropriately in circumstances that were previously less contested and problematic. Furthermore, signalling respect and consideration towards others via polite speech or behaviour is more likely to go awry during COVID-19. Additionally, the lack of clarity surrounding norms of politeness may prevent polite acts from helping to mitigate conflict and facilitate cooperative social exchange. Finally, citizens and politicians can exploit disruptions around politeness norms to engage in behaviour that under normal circumstances would be considered impolite. The chapter also identifies potential solutions that governments, businesses, and citizens can adopt to respond to these challenges.

Civility as Politeness During COVID-19

The outbreak of COVID-19 pandemic is a great economic shock, both for the European countries and for the entire world. The subject of the study is the unexpected profits or losses connected with the coronavirus pandemic. The authors of the article focus on the areas affected by losses and the areas, which achieved windfall profits during the discussed period. The purpose of this article is to analyze and evaluate the profits and losses resulting from the ongoing SARS-CoV-2 pandemic. The world economy has been struggling with epidemic phenomena, varying in intensity and extent, since at least the Roman Empire. This is also the case when the global economy is affected by the pandemic. The business environment has radically evolved. The pandemic contributed to losses in many areas, the most influenced fields are the following: aviation, hospitality and tourism. Profits, on the other hand, relate to the Zoom company, which enables and facilitates videoconferencing, it is so important in the case of remote work. Online shops, such as Amazon, have also recorded an increase, especially during the closure of brick and mortar shops. Stock market increases were also observed among companies supplying food and food products. It should be emphasized, however, that the financial situation of individual companies also depends on the principals and permanent contracts.

Windfall profits and losses caused by the COVID-19 pandemic

The geriatric population constitutes a large slice of the population of Western countries and a class of fragile patients, with greater deaths due to COVID-19. The patterns of healthcare utilization change during pandemic disease outbreaks. Identifying the patterns of changes of this particular fragile subpopulation is important for future preparedness and response. Overcrowding in the emergency department (ED) can occur because of the volume of patients waiting to be seen, delays in patient assessment or treatment in the ED, or impediments to leaving the ED once the treatment has been completed. Overcrowding has become a serious and growing issue globally, which represents a serious impediment to healthcare utilization. To estimate the rate of ED visits attributable to the outbreak and guide the planning of strategies for managing ED access or after the outbreak of transmittable respiratory diseases. This observational study was based on a retrospective review of the epidemiological and clinical records of patients aged > 75 years who visited the Foundation IRCCS Policlinic San Matteo during the first wave of COVID-19 outbreak (February 21 to May 1, 2020; pandemic group). The analysis methods included estimation of the changes in the epidemiological and clinical data from the annual baseline data after the start of the COVID-19 pandemic. Outcome measures and analysis: Primary objective is the evaluation of ED admission rate change and ED overcrowding. Secondary objectives are the evaluation of modes of ED access by reason and triage code, access types, clinical outcomes (such as admission and mortality rates). During the pandemic, ED crowding increased dramatically, although the overall number of patients decreased, in the face of a percentage increase in those with high-acuity conditions, because of changes in patient management that have prolonged length of stay (LOS) and increased rates of access block. Overcrowding during the COVID-19 pandemic can be attributed to the Access Block. Access Block solutions are hence required to prevent a recurrence of crowding to any new viral wave or new epidemic in the future. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-021-02732-w.

How the coronavirus disease 2019 pandemic changed the patterns of healthcare utilization by geriatric patients and the crowding: a call to action for effective solutions to the access block

MOTIVATION: Zoonosis, the natural transmission of infections from animals to humans, is a far-reaching global problem. The recent outbreaks of Zikavirus, Ebolavirus, and Coronavirus are examples of viral zoonosis, which occur more frequently due to globalization. In case of a virus outbreak, it is helpful to know which host organism was the original carrier of the virus to prevent further spreading of viral infection. Recent approaches aim to predict a viral host based on the viral genome, often in combination with the potential host genome and arbitrarily selected features. These methods are limited in the number of different hosts they can predict or the accuracy of the prediction. RESULTS: Here, we present a fast and accurate deep learning approach for viral host prediction, which is based on the viral genome sequence only. We tested our deep neural network (DNN) on three different virus species (influenza A virus, rabies lyssavirus, rotavirus A). We achieved for each virus species an AUC between 0.93 and 0.98, allowing highly accurate predictions while using only fractions (100-400 bp) of the viral genome sequences. We show that deep neural networks are suitable to predict the host of a virus, even with a limited amount of sequences and highly unbalanced available data. The trained DNNs are the core of our virus-host prediction tool VIDHOP (VIrus Deep learning HOst Prediction). VIDHOP also allows the user to train and use models for other viruses. AVAILABILITY: VIDHOP is freely available under https://github.com/flomock/vidhop SUPPLEMENTARY INFORMATION: Available at DOI 10.17605/OSF.IO/UXT7

VIDHOP, viral host prediction with Deep Learning

Herpes zoster ophthalmicus (HZO), which is an ophthalmological emergency, accounts for 10%-20% of all Herpes zoster (HZ) cases. HZ infection in COVID-19 vaccinated individuals who are immunocompetent can be attributed to vaccine-induced immunomodulation allowing the varicella-zoster virus (VZV) to escape from the dorsal root ganglia. Another theory is similar to immune reconstitution syndrome (IRS). HZ infection in a young immunocompetent individual is a rare entity. As per our literature review, only four cases have been reported thus far. We are reporting two cases of two young individuals with no known risk factors who developed ipsilateral HZO after receiving the COVID-19 vaccination. The increasing incidence of HZ cases post COVID-19 vaccine indicates that this is not a mere coincidence. Awareness must be created among physicians, as well as the general population, for early recognition and early antiviral usage, which can halt the progression of the disease and thus prevent debilitating complications.

Ipsilateral Zoster Ophthalmicus Post COVID-19 Vaccine in Healthy Young Adults

Backgroud : Both Chlamydia psittaci and COVID-19 virus can cause lung inflammation, which manifests extremely similarly in clinical symptoms and imaging. Especially during the epidemic of COVID-19, psittacosis pneumonia is easily misdiagnosed as COVID-19 pneumonia. The identification of the chest imaging between the two diseases is of special significance when the epidemiological contact history is unclear, and the etiology and nucleic acid test results are not available. This study conducts to compare the imaging characteristics on chest high-resolution CTs (HRCT) between patients with psittaci pneumonia and COVID-19 pneumonia. Methods: : A retrospective analysis of the imaging characteristics on chest HRCTs of 10 psittaci pneumonia patients and 13 COVID-19 pneumonia patients. The similarities and differences in HRCT images of patients with psittaci pneumonia and COVID-19 pneumonia were analyzed. Results: : HRCT showed that among the 10 psittaci pneumonia patients, 8 cases (80.00%) had single lobe involvement, and 2 cases (20.00%) had multiple lobe involvement. Among the 13 COVID-19 pneumonia patients, 2 cases had single lobe involvement (15.38%), and 11 cases had multiple lobe involvement (84.62%). The types of lesions in 10 psittaci pneumonia patients included simple consolidation in 5 cases (50.00%), and ground-glass opacity (GGO) with consolidation in 5 cases (50.00%). The types of lesions in 13 COVID-19 pneumonia patients included simple GGO in 6 cases (46.15%), GGO with consolidation in 4 cases (30.77%), GGO with paving stone sign in 2 cases (15.38%), and simple consolidation in 1 case (7.69%). Lymphadenopathy was observed in 1 psittaci pneumonia patient (10.00%) and 1 COVID-19 pneumonia patient (7.69%). Among the 10 psittaci pneumonia patients, 8 cases (80.00%) had bronchial inflation, and 6 patients (60.00%) had pleural effusion. Among the 13 COVID-19 pneumonia patients, 5 patients (38.46%) showed signs of bronchial inflation, while no pleural effusion was observed in 13 patients. Conclusion: : Chest HRCTs can distinguish COVID-19 pneumonia from psittaci pneumonia, and can provide early diagnoses of these two diseases.

Comparative Study of HRCT Imaging Characteristics of Psittaci Pneumonia and COVID-19 Pneumonia

About 20% of individuals with anorexia nervosa (AN) remain chronically ill. Therefore, early identification of poor outcome could improve care. Genetic research has identified regions of the genome associated with AN. Patients with anorexia nervosa were identified via the Swedish eating disorder quality registers Stepwise and Riksät and invited to participate in the Anorexia Nervosa Genetics Initiative. First, we associated genetic information longitudinally with eating disorder severity indexed by scores on the Clinical Impairment Assessment (CIA) in 2843 patients with lifetime AN with or without diagnostic migration to other forms of eating disorders followed for up to 16 years (mean = 5.3 years). Second, we indexed the development of a severe and enduring eating disorder (SEED) by a high CIA score plus a follow-up time ≥5 years. We associated individual polygenic scores (PGSs) indexing polygenic liability for AN, schizophrenia, and body mass index (BMI) with severity and SEED. After multiple testing correction, only the BMI PGS when calculated with traditional clumping and p value thresholding was robustly associated with disorder severity (ßPGS = 1.30; 95% CI: 0.72, 1.88; p = 1.2 × 10-5) across all p value thresholds at which we generated the PGS. However, using the alternative PGS calculation method PRS-CS yielded inconsistent results for all PGS. The positive association stands in contrast to the negative genetic correlation between BMI and AN. Larger discovery GWASs to calculate PGS will increase power, and it is essential to increase sample sizes of the AN GWASs to generate clinically meaningful PGS as adjunct risk prediction variables. Nevertheless, this study provides the first evidence of potential clinical utility of PGSs for eating disorders.

Polygenic association with severity and long-term outcome in eating disorder cases

Severe acute respiratory syndrome (SARS) coronavirus (CoV)-2 (SARS-CoV-2) is a novel coronavirus identified as the cause of coronavirus disease-2019 (COVID-19) that began in Wuhan, China in late 2019 and spread now in 210 countries and territories around the world. Many people are asymptomatic or with mild symptoms. However, in some cases (usually the elderly and those with comorbidities) the disease may progress to pneumonia, acute respiratory distress syndrome and multi-organ dysfunction that can lead to death. Such wide interindividual differences in response to SARS-CoV-2 infection may relate to several pathogen-and host-related factors. These include the different levels of the ubiquitously present human angiotensin I converting enzyme 2 (ACE2) receptors gene expression and its variant alleles, the different binding affinities of ACE2 to the virus spike (S) protein given its L-and S-subtypes and the subsequent extent of innate immunity-related hypercytokinemia. The extensive synthesis of cytokines and chemokines in coronavirus diseases was suggested as a major factor in exacerbating lung damage and other fatal complications. The polymorphisms in genes coding for pro-inflammatory cytokines and chemokines have been associated with mediating the response and susceptibility to a wide range of infections and their severe outcomes. Understanding the nature of pathogen–host interaction in COVID-19 symptomatology together with the role of hypercytokinemia in disease severity may permit developing new avenues of approach for prevention and treatment and can delineate public health measures to control the spread of the disease.

Hypercytokinemia and pathogen–host interaction in covid-19

In 2019, a new coronavirus (2019-nCoV) infecting Humans has emerged in Wuhan, China. Its genome has been sequenced and the genomic information promptly released. Despite a high similarity with the genome sequence of SARS-CoV and SARS-like CoVs, we identified a peculiar furin-like cleavage site in the Spike protein of the 2019-nCoV, lacking in the other SARS-like CoVs. In this article, we discuss the possible functional consequences of this cleavage site in the viral cycle, pathogenicity and its potential implication in the development of antivirals.

The spike glycoprotein of the new coronavirus 2019-nCoV contains a furin-like cleavage site absent in CoV of the same clade

BACKGROUND: Before the COVID-19 pandemic, access to otolaryngology and head-and-neck surgery was limited in low- and middle-income countries (LMICs). The pandemic has increased the burden on LMIC health systems by causing unanticipated expenses, delayed care, and changes in research activity. We aimed to assess the landscape of global ENT research during the pandemic. MATERIALS AND METHODS: The authors developed a search strategy composed of the following keywords: “otolaryngology,” “head and neck surgery,” and “low- and middle-income countries.” Then, they searched eleven citation databases via the Web of Science from January 01, 2020, to May 03, 2021. They imported the result as metadata into VosViewer and ran bibliometric analyses to identify the most influential institutions, countries, and themes. RESULTS: During the study period, 3077 articles were published. Two hundred eighty-nine articles (9%) mentioned COVID-19 explicitly. The second most common theme was pediatric ENT (223 articles, 7%). The United States had the most publications [1616 articles, 12,033 citations, and 2986 total link strength (TLS)], followed by China (336 articles, 10,981 citations, and 571 TLS). South Africa, the first African country, was fourth (302 articles, 699 citations, and 908 TLS), while Brazil, the first South American country, was seventh (158 articles, 582 citations, and 376 TLS). The most prolific institution was the National Institute of Allergy and Infectious Diseases (186 articles, 1110 citations, and 674 TLS). CONCLUSION: COVID-19 was the most common research theme during the pandemic, surpassing pediatric ENT.

Global head and neck surgery research during the COVID pandemic: A bibliometric analysis