title: Aged Mice are More Resistant to Influenza Virus Infection due to Reduced Inflammation and Lung Pathology

text: Immune responses are a double-edged sword. Effective and appropriate immune responses capable of controlling viral infection while also largely preserving tissue integrity, are critical for host survival. Too strong immune responses might result in immune pathology, while too weak immune responses might cause viral persistence. Physiologic ageing is accompanied with a decline in the normal functioning of the immune system, which is termed as "immunosenescence". We show that aged mice (16-19 months old) are more resistant to influenza A virus (IAV) infection than the young mice. Strong immune responses in the young mice after IAV infection result in faster clearance of virus, but also cause severe lung injury and higher mortality rate. While in the aged mice, the delayed and milder immune responses contribute to reduced pulmonary damage, and are still capable to clear the infection even with a slower kinetics, displaying a more resistant phenotype during IAV infection. Hence, our work demonstrates that moderate immune responses as a decline with ageing in the aged mice balance the immune pathology and viral clearance, might be beneficial for the host during certain circumstances. Our results provide important insight to our basic knowledge of immunosenescence and immune defenses to invading pathogens. Further, our results indicate that age factors should be considered when investigating the vaccination and therapeutic strategies for severe IAV infection.


title: The application of Temporary Ark Hospitals in controlling COVID‐19 spread: the experiences of one Temporary Ark Hospital, Wuhan, China

text: BACKGROUND: The outbreak of coronavirus disease 2019 (COVID‐19) in Wuhan, Hubei Province, China spread worldwide, resulting in a large number of deaths. METHODS: Temporary Ark hospitals (TAH) have played an important role in controlling the spread of the epidemic in the city of Wuhan. Taking one TAH with 800 beds as an example, we summarized details of the layout, setting, working mode of medical staffs, patient management, admission standards, discharge standards, and standards for transferring to another hospital, hospital operation, and so on. RESULTS: Over the period of operation, a total of 1,124 patients were admitted for treatment. Of these, 833 patients were cured and discharged from the hospital and 291 patients were transferred to other designated hospitals owing to aggravation of their condition. The achievement is to have zero infection for medical staff, zero in‐hospital deaths among admitted patients, and zero readmission for discharged patients. CONCLUSION: The rapid deployment of TAH provided a suitable place for treating mild/moderate or no asymptomatic COVID‐19 patients and successfully helped to control the infection in Wuhan. The successful model of TAH would rapidly and effectively control the spread of COVID‐19 in other cities. This article is protected by copyright. All rights reserved.


title: COVID-19 Preparedness in U.S. Home Healthcare Agencies

text: Abstract Objectives In the U.S., home health agencies (HHAs) provide essential services for patients recovering from post-acute-care and older adults who are aging in place. During the COVID-19 pandemic, HHAs may face additional challenges caring for these vulnerable patients. Our objective was to explore COVID-19 preparedness of U.S. HHAs and compare results by urban/rural location. Design Cross-sectional study. Setting/Participants Using a stratified random sample of 978 HHAs, we conducted a 22-item online survey from April 10 to 17, 2020. Methods Summary statistics were computed; open-ended narrative responses were synthesized using qualitative methods. Results Similar to national data, most responding HHAs (n=121, 12% response rate) were for-profit and located in the South. A majority of HHAs had infectious disease outbreaks included in their emergency preparedness plan (76%), a staff member in charge of outbreak/disaster preparedness (84%), and had provided their staff with COVID-19 education and training (97%). More urban HHAs had cared for confirmed and recovered COVID-19 patients than rural HHAs, but urban HHAs had less capacity to test for COVID-19 than rural HHAs (9% vs 21%). Most (69%) experienced patient census declines and had a current and/or anticipated supply shortage. Rural agencies were impacted less than urban agencies. HHAs have already rationed (69%) or implemented extended use (55%) or limited reuse (61%) of personal protective equipment (PPE). Many HHAs reported accessing supplemental PPE from state/local resources, donations, and do-it-yourself efforts; more rural HHAs had accessed these additional resources compared to urban HHAs. Conclusions/Implications This survey reveals challenges that HHAs are having in responding to the COVID-19 pandemic, particularly among urban agencies. Of greatest concern are the declines in patient census, which drastically impact agency revenue, and the shortages of PPE and disinfectants. Without proper protection, HHA clinicians are at risk of self-exposure and viral transmission to patients and vulnerable family members.


title: Emerging Developments on Pathogenicity, Molecular Virulence, Epidemiology and Clinical Symptoms of Current Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

text: Abstract Middle East respiratory syndrome coronavirus (MERS-CoV) is a recently reported virus that is associated with severe, life threatening and rapidly spreading primarily respiratory illness called the Middle East respiratory syndrome. MERS-CoV possesses a unique positive-sense single-stranded RNA and can undergo rapid mutation in the viral genome. This results in antigenic switching and genetic variation, finally leading to the emergence of novel and new MERS-CoV subtypes which are uncontrollable by vaccines. Researchers are also finding difficulties to sort out therapeutic intervention strategies for MERS-CoV. This virus can spread from human to human, but transmission from dromedary camels to humans plays a crucial epidemiological significance. Dromedary camel acts as “gene mixing vessels” for MERS-CoV and these virus particles undergo rapid change in them. Viral receptors called dipeptidyl peptidase-4 are important receptors for attachment and spread of MERS-CoV in humans. The current method of laboratory confirmation is through real-time polymerase chain reaction on bronchoalveolar lavage, sputum and tracheal aspirates. Unfortunately, till today there are no definite anti-viral drugs available for MERS-CoV.


Commentary: Adapting the Practice of Congenital Heart Surgery to the Covid-19 Pandemic


Practices respond to call to help the NHS.


title: Histopathology of Pneumocystis carinii pneumonia in immunocompetent laboratory rats

text: The occurrence of idiopathic pulmonary lesions in laboratory rats, characterized by lymphohistiocytic interstitial pneumonia with dense perivascular lymphoid cuffs, has been reported over the past decade. Although the term rat respiratory virus (RRV) was adopted to confer a putative viral etiology to the idiopathic pulmonary lesions, the etiology of this disease remains to be elucidated. Recently, inflammatory lesions have been observed in the lungs of immunocompetent laboratory rats similar to those previously described. Based on the latest evidence indicating that Pneumocystis carinii (P. carinii), and not putative RRV, causes infectious interstitial pneumonia in laboratory rats, the present study investigated whether the pulmonary lesions observed were caused by P. carinii infection. Male Sprague-Dawley rats, free of known pathogens, were introduced into a rat colony positive for RRV-type lesions. Routine histopathological examinations were performed on the rat lung tissues following exposure. The presence of Pneumocystis organisms was confirmed using Grocott’s methenamine silver (GMS) staining. At week 3 following introduction, a few small lymphoid aggregates were located adjacent to the edematous vascular sheath. By week 5, foci of dense perivascular lymphoid cuffing were observed. Multifocal lymphohistiocytic interstitial pneumonia and prominent lymphoid perivascular cuffs were observed between week 7 and 10. GMS staining confirmed the presence of Pneumocystis cysts. Thus, the results of the present study demonstrated that P. carinii caused lymphohistiocytic interstitial pneumonia in a group of laboratory rats. The observations strongly support the conclusion that P. carinii infection in immunocompetent laboratory rats causes the lung lesions that were previously attributed to RRV.


title: Gene-expression profiling of HIV-1 infection and perinatal transmission in Botswana

text: Perinatal transmission of human immunodeficiency virus (HIV)-1 represents a major problem in many regions of the world, especially Southern Africa. With the exception of viral and proviral load, the role for maternal cofactors in perinatal transmission outcome is largely unknown. In this study, an assessment was made of peripheral blood mononuclear cells (PBMC) gene-expression profiles to better understand transcriptional changes associated with HIV-1 infection and perinatal transmission among young adult mothers with infants in Botswana. Peripheral blood mononuclear cells specimens were used from 25 HIV+ drug naive and 20 HIV− healthy mothers, similar in age and location, collected in 1999–2000 and 2003, and processed with the exact same methods, as previously described. Expression profiling of 22 277 microarray gene probes implicated a broad initiation of innate response gene-sets, including toll-like receptor, interferon-stimulated and antiviral RNA response pathways in association with maternal HIV-1 infection. Maternal transmission status was further associated with host genes that influence RNA processing and splicing patterns. In addition to real-time polymerase chain reaction validation of specific genes, enriched category validation of PBMC profiles was conducted using two independent data sets for either HIV-1 infection or an unrelated RNA virus, severe acute respiratory virus infection. HIV-1 pathogen-specific host profiles should prove a useful tool in infection and transmission intervention efforts worldwide. SUPPLEMENTARY INFORMATION: The online version of this article (doi:10.1038/sj.gene.6364297) contains supplementary material, which is available to authorized users.


title: Influence of trust on two different risk perceptions as an affective and cognitive dimension during Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in South Korea: serial cross-sectional surveys

text: OBJECTIVES: This study aimed to assess the affective and cognitive risk perceptions in the general population of Middle East respiratory syndrome (MERS) during the 2015 MERS coronavirus (MERS-CoV) outbreak in South Korea and the influencing factors. DESIGN: Serial cross-sectional design with four consecutive surveys. SETTING: Nationwide general population in South Korea. PARTICIPANTS: Overall 4010 respondents (aged 19 years and over) from the general population during the MERS-CoV epidemic were included. PRIMARY AND SECONDARY OUTCOME MEASURES: The main outcome measures were (1) affective risk perception, (2) cognitive risk perception, and (3) trust in the government. Multivariate logistic regression models were used to identify factors (demographic, socioeconomic, area and political orientation) associated with risk perceptions. RESULTS: Both affective and cognitive risk perceptions decreased as the MERS-CoV epidemic progressed. Proportions of affective risk perception were higher in all surveys and slowly decreased compared with cognitive risk perception over time. Females (adjusted OR (aOR) 1.72–2.00; 95% CI 1.14 to 2.86) and lower self-reported household economic status respondents were more likely to perceive the affective risk. The older the adults, the higher the affective risk perception, but the lower the cognitive risk perception compared with younger adults. The respondents who had low trust in the government had higher affective (aOR 2.19–3.11; 95 CI 1.44 to 4.67) and cognitive (aOR 3.55–5.41; 95 CI 1.44 to 9.01) risk perceptions. CONCLUSIONS: This study suggests that even if cognitive risk perception is dissolved, affective risk perception can continue during MERS-CoV epidemic. Risk perception associating factors (ie, gender, age and self-reported household economic status) appear to be noticeably different between affective and cognitive dimensions. It also indicates that trust in the government influences affective risk perception and cognitive risk perception. There is a need for further efforts to understand the mechanism regarding the general public’s risk perception for eﬀective risk communication.


title: Jigsaw falling into place: A review and perspective of lymphoid tissue CD8+ T cells and control of HIV

text: CD8+ T cells are crucial for immunity against viral infections, including HIV. Several characteristics of CD8+ T cells, such as polyfunctionality and cytotoxicity, have been correlated with effective control of HIV. However, most of these correlates have been established in the peripheral blood. Meanwhile, HIV primarily replicates in lymphoid tissues. Therefore, it is unclear which aspects of CD8+ T cell biology are shared and which are different between blood and lymphoid tissues in the context of HIV infection. In this review, we will recapitulate the latest advancements of our knowledge on lymphoid tissue CD8+ T cells during HIV infection and discuss the insights these advancements might provide for the development of a HIV cure.


title: Novel Betaherpesvirus in Bats

text: Because bats are associated with emerging zoonoses, identification and characterization of novel viruses from bats is needed. Using a modified rapid determination system for viral RNA/DNA sequences, we identified a novel bat betaherpesvirus 2 not detected by herpesvirus consensus PCR. This modified system is useful for detecting unknown viruses.


title: Sequential coupling between COPII and COPI vesicle coats in endoplasmic reticulum to Golgi transport

text: COPI and COPII are vesicle coat complexes whose assembly is regulated by the ARF1 and Sar1 GTPases, respectively. We show that COPI and COPII coat complexes are recruited separately and independently to ER (COPII), pre-Golgi (COPI, COPII), and Golgi (COPI) membranes of mammalian cells. To address their individual roles in ER to Golgi transport, we used stage specific in vitro transport assays to synchronize movement of cargo to and from pre-Golgi intermediates, and GDP- and GTP-restricted forms of Sar1 and ARF1 proteins to control coat recruitment. We find that COPII is solely responsible for export from the ER, is lost rapidly following vesicle budding and mediates a vesicular step required for the build-up of pre-Golgi intermediates composed of clusters of vesicles and small tubular elements. COPI is recruited onto pre-Golgi intermediates where it initiates segregation of the anterograde transported protein vesicular stomatitis virus glycoprotein (VSV-G) from the retrograde transported protein p58, a protein which actively recycles between the ER and pre-Golgi intermediates. We propose that sequential coupling between COPII and COPI coats is essential to coordinate and direct bi-directional vesicular traffic between the ER and pre-Golgi intermediates involved in transport of protein to the Golgi complex.


title: Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis

text: BACKGROUND: Guidelines do not currently recommend the use of lung ultrasound (LUS) as an alternative to chest X-ray (CXR) or chest computerized tomography (CT) scan for the diagnosis of pneumonia. We conducted a meta-analysis to summarize existing evidence of the diagnostic accuracy of LUS for pneumonia in adults. METHODS: We conducted a systematic search of published studies comparing the diagnostic accuracy of LUS against a referent CXR or chest CT scan and/or clinical criteria for pneumonia in adults aged ≥18 years. Eligible studies were required to have a CXR and/or chest CT scan at the time of evaluation. We manually extracted descriptive and quantitative information from eligible studies, and calculated pooled sensitivity and specificity using the Mantel-Haenszel method and pooled positive and negative likelihood ratios (LR) using the DerSimonian-Laird method. We assessed for heterogeneity using the Q and I(2) statistics. RESULTS: Our initial search strategy yielded 2726 articles, of which 45 (1.7%) were manually selected for review and 10 (0.4%) were eligible for analyses. These 10 studies provided a combined sample size of 1172 participants. Six studies enrolled adult patients who were either hospitalized or admitted to Emergency Departments with suspicion of pneumonia and 4 studies enrolled critically-ill adult patients. LUS was performed by highly-skilled sonographers in seven studies, by trained physicians in two, and one did not mention level of training. All studies were conducted in high-income settings. LUS took a maximum of 13 minutes to conduct. Nine studies used a 3.5-5 MHz micro-convex transducer and one used a 5–9 MHz convex probe. Pooled sensitivity and specificity for the diagnosis of pneumonia using LUS were 94% (95% CI, 92%-96%) and 96% (94%-97%), respectively; pooled positive and negative LRs were 16.8 (7.7-37.0) and 0.07 (0.05-0.10), respectively; and, the area-under-the-ROC curve was 0.99 (0.98-0.99). CONCLUSIONS: Our meta-analysis supports that LUS, when conducted by highly-skilled sonographers, performs well for the diagnosis of pneumonia. General practitioners and Emergency Medicine physicians should be encouraged to learn LUS since it appears to be an established diagnostic tool in the hands of experienced physicians.


title: Reflexiones derivadas de la pandemia COVID-19

text: Resumen Cuando redactábamos las recomendaciones para el plan de contingencia conjunto entre la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC) y la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) los hechos iban por delante de las predicciones ante la magnitud de la pandemia del COVID-19. Socios y socias nos informaban de la falta de equipos de protección individual (EPI), la habilitación rápida de UCI improvisadas en zonas varias de hospitales y el reclutamiento de enfermeras para cubrir turnos. La falta de reconocimiento de la especialidad enfermera en cuidados críticos, englobada dentro la macroespecialidad de enfermería medicoquirúrgica, todavía sin desarrollar, ha puesto de relieve la necesidad urgente de aprender de los errores: especialidad, aumentar dotaciones en los equipos de enfermería y proteger el sistema sanitario público. Abstract While we were drafting the recommendations for the joint contingency plan between the Spanish Society of Intensive Care and Coronary Unit Nursing (SEEIUC) and the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), predictions were overtaken by events with regard to the magnitude of the COVID-19 pandemic. Members informed us of the lack of personal protection equipment (PPE), the rapid provision of improvised ICUs in various hospital areas and the recruitment of nurses to cover shifts. The failure to recognise the specialty of critical care nursing, included in the macro-specialty of medical-surgical nursing and not yet developed, has highlighted the urgent need to learn from our mistakes: specialisation, increase the number of nurses in teams and protect the public health system.


title: Planning and priority setting for vaccine development and immunization()

text: We review a sequence of strategic planning efforts over time in the United States, all involving processes to prioritize new vaccine candidates. The Institute of Medicine of the National Academies of Sciences, Engineering, and Medicine has been involved in three priority setting processes, each using different metrics and methodologies: infant mortality equivalents (1985–1986), cost-effectiveness (2000), and more recently, the implementation of a software system based on a broader multi-criteria systems approach that can include either of the earlier metrics among other various considerations (2015). The systems approach offers users the flexibility to select, combine, rank, weigh and evaluate different attributes representing their perspectives, assumptions, and particular needs. This approach also overcomes concerns relating to the previous single-metric ranking approaches that yielded lists that, once published, were static, and could not readily accommodate new information about emerging pathogens, new scientific advances, or changes in the costs and performance features of interventions. We discuss the rationale and reasoning behind the design of this multi-criteria decision support approach, stakeholder feedback about the tool, and highlight the potential advantages from using this expanded approach to better inform and support vaccine policies.


title: Features of Mild-to-Moderate COVID-19 Patients with Dysphonia.

text: INTRODUCTION: To explore the prevalence of dysphonia in European patients with mild-to-moderate COVID-19 and the clinical features of dysphonic patients. METHODS: The clinical and epidemiological data of 702 patients with mild-to-moderate COVID-19 were collected from 19 European Hospitals. The following data were extracted: age, sex, ethnicity, tobacco consumption, comorbidities, general and otolaryngological symptoms. Dysphonia and otolaryngological symptoms were self-assessed through a 4-point scale. The prevalence of dysphonia, as part of the COVID-19 symptoms, was assessed. The outcomes were compared between dysphonic and non-dysphonic patients. The association between dysphonia severity and outcomes was studied through Bayesian analysis. RESULTS: A total of 188 patients were dysphonic, accounting for 26.8% of cases. Females developed more frequently dysphonia than males (p=0.022). The proportion of smokers was significantly higher in the dysphonic group (p=0.042). The prevalence of the following symptoms was higher in dysphonic patients compared with non-dysphonic patients: cough, chest pain, sticky sputum, arthralgia, diarrhea, headache, fatigue, nausea and vomiting. The severity of dyspnea, dysphagia, ear pain, face pain, throat pain and nasal obstruction was higher in dysphonic group compared with non-dysphonic group. There were significant associations between the severity of dysphonia, dysphagia and cough. CONCLUSION: Dysphonia may be encountered in a quarter of patients with mild-to-moderate COVID-19 and should be considered as a symptom list of the infection. Dysphonic COVID-19 patients are more symptomatic than non-dysphonic individuals. Future studies are needed to investigate the relevance of dysphonia in the COVID-19 clinical presentation.


title: Estimation of population’s response to mitigation measures and self-perceived behaviours against COVID-19 Pandemic

text: Abstract Objectives Since March 2020, a rapid increase has been observed in the prevalence of the COVID-19 pandemic, which has essentially resulted from increased disease transmission and intensified testing and reporting. The international guidelines for the prevention and treatment of the COVID-19 pandemic have been frequently updated. Such guidelines assist the governmental regulatory bodies in taking optimal measures and safeguarding their citizens against the pandemic. We conducted a short survey with a Saudi cohort to understand the awareness about COVID-19 and estimate the responses for mitigation strategies. Methods An electronic survey was conducted, and the first 388 responses were analysed for publishing an initial report. The questionnaire comprised 27 items and was divided into three sections, namely demographic, awareness, and response to mitigation strategies and participants’ self-perceived behaviours regarding COVID-19. The perceptions of the participants were compared with their responses to mitigation measures. Results In our study, 89.7% understood the meaning of pandemic, while 82.2% correctly identified that the elderly belonged to a high-risk group for the COVID-19 infection. As many as 96.1% agreed that staying at home was one of the mitigation strategies. Nearly 35% preferred self-medication. Higher educational level (OR: 2.09, 95% CI: 1.02- 4.29) and longer working hours were found to be significantly associated with a positive response to mitigation measures with p<0.04 and p<.02, respectively. Conclusions We report better understanding and appropriate response to mitigation measures towards the COVID-19 pandemic among the general population in Saudi Arabia. Nevertheless, the tendency towards self-medication was reported by one-third of the responders.


title: Acute Gastroenteritis

text: Acute gastroenteritis is a common infectious disease syndrome, causing a combination of nausea, vomiting, diarrhea, and abdominal pain. There are more than 350 million cases of acute gastroenteritis in the United States annually and 48 million of these cases are caused by foodborne bacteria. Traveler’s diarrhea affects more than half of people traveling from developed countries to developing countries. In adult and pediatric patients, the prevalence of Clostridium difficile is increasing. Contact precautions, public health education, and prudent use of antibiotics are necessary goals in decreasing the prevalence of Clostridium difficle. Preventing dehydration or providing appropriate rehydration is the primary supportive treatment of acute gastroenteritis.


title: Suction Mitigation of Airborne Particulate Generated During Sinonasal Drilling and Cautery

text: INTRODUCTION: COVID‐19 has significantly impacted endonasal surgery, and recent experimentation has demonstrated that sinonasal drilling and cautery have significant propensity for airborne particulate generation immediately adjacent to the surgical field. In the present investigation, we assess nasopharyngeal suctioning as a mitigation strategy to decrease particulate spread during simulated endonasal surgical activity. METHODS: Airborne particulate generation in the 1‐10μm range was quantified with an optical particle sizer in real‐time during cadaveric‐simulated anterior and posterior endonasal drilling and cautery conditions. To test suction mitigation, experiments were performed both with and without a rigid suction placed in the contralateral nostril, terminating in the nasopharynx. RESULTS: Both anterior (medial maxillary wall and nasal septum) and posterior (sphenoid rostrum) drilling produced significant particulate generation in the 1‐10μm range throughout the duration of drilling (p<0.001) without the use of suction, while nasopharyngeal suction use eliminated the detection of generated airborne particulate. A similar effect was seen with nasal cautery, with significant particle generation (p<0.001) that was reduced to undetectable levels with the use of nasopharyngeal suction. CONCLUSIONS: The use of nasopharyngeal suctioning via the contralateral nostril minimizes airborne particulate spread during simulated sinonasal drilling and cautery. In the era of COVID‐19, this technique offers an immediately available measure that may increase surgical safety. This article is protected by copyright. All rights reserved


It is Unlikely That Influenza Viruses Will Cause a Pandemic Again Like What Happened in 1918 and 1919


title: Common Pediatric Respiratory Emergencies

text: Pediatric respiratory illnesses are a huge burden to emergency departments worldwide. This article reviews the latest evidence in the epidemiology, assessment, management, and disposition of children presenting to the emergency department with asthma, croup, bronchiolitis, and pneumonia.


title: Harmonising the virological surveillance of influenza in Europe: results of an 18-country survey

text: Abstract The European influenza surveillance scheme (EISS) is based on a surveillance model that combines clinical and virological data in the general population. Eighteen countries in Europe report weekly influenza activity to EISS (http://www.eiss.org). A questionnaire on the virological data collection was sent electronically to the EISS members. Questions on the specimen collection, representativity, laboratory diagnosis of influenza, reporting of variants, testing for other respiratory infections, serological testing, near-patient tests and preparedness for a pandemic were included. The results of the survey showed that for the typing of influenza, the methods polymerase chain reaction (PCR), enzyme-linked immunosorbent assay (ELISA) and haemagglutination inhibition (HAI) methods are used most frequently. For the subtyping of influenza, HAI and PCR are used most often. An east-west divide was seen for the use of PCR in typing and subtyping (more PCR use in the west). Differences in the virological surveillance systems in Europe can make direct comparisons difficult because detection rates may differ by test. For the reporting of other respiratory infections besides influenza, many networks (68%) collect information on RSV. This is important because RSV causes similar clinical symptoms as influenza and can have a similar impact in terms of burden of disease. With the collection of RSV data, EISS is moving to a broader spectrum of viral respiratory diseases. The findings of this survey will be used to better harmonise laboratory methods in EISS in order to obtain more reliable and comparable information on influenza activity in Europe.


title: Developments, Evolution, and Implications of National Diagnostic Criteria for COVID-19 in China

text: Recently WHO has characterized COVID-19 as a pandemic. Diagnosing the disease accurately and decreasing misdiagnoses and missed diagnoses is very important for management. Therefore, we have analyzed the seven versions of China's national guidelines to examine how the diagnostic criteria roadmap has developed and evolved, in order to share our experience worldwide. In this article, we present the developments from the first to seventh versions, involving changes of case classification, changes to “suspected case,” changes in “confirmed case,” changes in clinical classifications, changes in “severe case,” and unchanged criteria. We have also discussed the reasons and implications for these changes and are looking forward to providing suggestions for worldwide understanding and management of this pandemic. A nucleic acid test is currently accepted as the gold standard method to confirm diagnosis. In addition, imaging examination and epidemiological history should also be considered as auxiliary diagnosis methods.


Chapter 11 Pathology The Clinical Description of Human Disease


title: SARS-CoV-2 Fulminant Myocarditis

text: ABSTRACT A 18-year-old man without prior medical history developed fulminant myocarditis concomitant to severe COVID-19 pneumonia and confirmed by serial cardiac magnetic resonance. This may have important diagnostic, monitoring, and pathogenic implications.


Praticiens de la cavité orale. Recommandations professionnelles. Risques infectieux par le COVID-19. Faire front pour faire face


title: Hand disinfection in the combat against Covid‐19

text: The World Health Organization (WHO) has declared a global health emergency over a new coronavirus. The new corona virus (SARS‐CoV‐2) has raised global attention with raising concerns of rapid spread from human‐to‐human. Like severe acute respiratory syndrome (SARS)‐nCoV, 2019‐nCoV can be passed directly from person to person by respiratory droplets, and may also be transmitted through contact and fomites.


title: Granulocyte-targeted therapies for airway diseases

text: Abstract The average respiration rate for an adult is 12-20 breaths per minute, which constantly exposes the lungs to allergens and harmful particles. As a result, respiratory diseases, which includes asthma, chronic obstructive pulmonary disease (COPD) and acute lower respiratory tract infections (LTRI), are a major cause of death worldwide. Although asthma, COPD and LTRI are distinctly different diseases with separate mechanisms of disease progression, they do share a common feature – airway inflammation with intense recruitment and activation of granulocytes and mast cells. Neutrophils, eosinophils, basophils, and mast cells are crucial players in host defense against pathogens and maintenance of lung homeostasis. Upon contact with harmful particles, part of the pulmonary defense mechanism is to recruit these cells into the airways. Despite their protective nature, overactivation or accumulation of granulocytes and mast cells in the lungs results in unwanted chronic airway inflammation and damage. As such, understanding the bright and the dark side of these leukocytes in lung physiology paves the way for the development of therapies targeting this important mechanism of disease. Here we discuss the role of granulocytes in respiratory diseases and summarize therapeutic strategies focused on granulocyte recruitment and activation in the lungs.


A Path to Resume Aesthetic Care: Executive Summary of Project AesCert Guidance Supplement—Practical Considerations for Aesthetic Medicine Professionals Supporting Clinic Preparedness in Response to the SARS-CoV-2 Outbreak


title: Analysis of the genome sequence of an alpaca coronavirus

text: Abstract Coronaviral infection of New World camelids was first identified in 1998 in llamas and alpacas with severe diarrhea. In order to understand this infection, one of the coronavirus isolates was sequenced and analyzed. It has a genome of 31,076 nt including the poly A tail at the 3′ end. This virus designated as ACoV-00-1381 (ACoV) encodes all 10 open reading frames (ORFs) characteristic of Group 2 bovine coronavirus (BCoV). Phylogenetic analysis showed that the ACoV genome is clustered closely (>99.5% identity) with two BCoV strains, ENT and LUN, and was also closely related to other BCoV strains (Mebus, Quebec, DB2), a human corona virus (strain 043) (>96%), and porcine hemagglutinating encephalomyelitis virus (>93% identity). A total of 145 point mutations and one nucleotide deletion were found relative to the BCoV ENT. Most of the ORFs were highly conserved; however, the predicted spike protein (S) has 9 and 12 amino acid differences from BCoV LUN and ENT, respectively, and shows a higher relative number of changes than the other proteins. Phylogenetic analysis suggests that ACoV shares the same ancestor as BCoV ENT and LUN.


Pandemics, Severity, and Context—Some Loose Ends


title: Advances in antivirals for non‐influenza respiratory virus infections

text: Progress in the development of antivirals for non‐influenza respiratory viruses has been slow with the result that many unmet medical needs and few approved agents currently exist. This commentary selectively reviews examples of where specific agents have provided promising clinical benefits in selected target populations and also considers potential therapeutics for emerging threats like the SARS and Middle East respiratory syndrome coronaviruses. Recent studies have provided encouraging results in treating respiratory syncytial virus infections in lung transplant recipients, serious parainfluenza virus and adenovirus infections in immunocompromised hosts, and rhinovirus colds in outpatient asthmatics. While additional studies are needed to confirm the efficacy and safety of the specific agents tested, these observations offer the opportunity to expand therapeutic studies to other patient populations.


title: Comparative Evaluation of Commercially Available Manual and Automated Nucleic Acid Extraction Methods for Rotavirus RNA Detection in Stool

text: Rotaviruses are a major cause of viral gastroenteritis in children. For accurate and sensitive detection of rotavirus RNA from stool samples by reverse transcription-polymerase chain reaction (RT-PCR), the extraction process must be robust. However, some extraction methods may not remove the strong RT-PCR inhibitors known to be present in stool samples. The objective of this study was to evaluate and compare the performance of six extraction methods used commonly for extraction of rotavirus RNA from stool, which have never been formally evaluated: the MagNA Pure Compact, KingFisher Flex and NucliSENS® easyMAG® instruments, the NucliSENS® miniMAG® semi-automated system, and two manual purification kits, the QIAamp Viral RNA kit and a modified RNaid® kit. Using each method, total nucleic acid or RNA was extracted from eight rotavirus-positive stool samples with enzyme immunoassay optical density (EIA OD) values ranging from 0.176 to 3.098. Extracts prepared using the MagNA Pure Compact instrument yielded the most consistent results by qRT-PCR and conventional RT-PCR. When extracts prepared from a dilution series were extracted by the 6 methods and tested, rotavirus RNA was detected in all samples by qRT-PCR but by conventional RT-PCR testing, only the MagNA Pure Compact and KingFisher Flex extracts were positive in all cases. RT-PCR inhibitors were detected in extracts produced with the QIAamp Viral RNA Mini kit. The findings of this study should prove useful for selection of extraction methods to be incorporated into future rotavirus detection and genotyping protocols.


Mitigate risks of medication interruption due to COVID‐19 for elderly with chronic diseases


title: Solid Phase Synthesis of Dual Labeled Peptides: Development of Cell Permeable Calpain Specific Substrates

text: A step-by-step evaluation of dual-labeled FRET substrates for the protease calpain is reported. The study led to cell permeable selections, with optimized specificity and effectiveness for the target enzyme, and improved stability to non-specific degrading enzymes.


title: Persisting SARS‐CoV‐2 viremia after rituximab therapy: Two cases with fatal outcome and a review of literature

text: BACKGROUND: COVID‐19 is an emerging infectious disease caused by SARS‐CoV‐2. The role of immunosuppression in disease course is not clear. Here we describe the lethal disease course in two SARS‐CoV‐2 infected patients after rituximab therapy. METHODS: Clinical data and laboratory findings of two SARS‐CoV‐2 infected rituximab treated patients were collected. SARS‐CoV‐2 RNA was detected in blood. RESULTS: Both patients developed severe respiratory failure. SARS‐CoV‐2 viremia persisted in both patients until they died on day 22 and 26 after admission. CONCLUSION: Rituximab therapy leads to severe combined immunodeficiency and these two cases indicate a high risk for fatal outcome after SARS‐CoV‐2 infection.


27 Pharyngitis


title: EMERGING SPECTRUM OF CARDIOPULMONARY PATHOLOGY OF THE CORONAVIRUS DISEASE 2019 (COVID-19): REPORT OF THREE AUTOPSIES FROM HOUSTON, TEXAS AND REVIEW OF AUTOPSY FINDINGS FROM OTHER UNITED STATES CITIES

text: Abstract This paper collates the pathological findings from initial published autopsy reports on 23 patients with Coronavirus Disease 2019 (COVID-19) from 5 centers in the United States of America, including 3 cases from Houston, Texas. Findings confirm that COVID-19 is a systemic disease with major involvement of the lungs and heart. Acute COVID-19 pneumonia has features of a distinctive acute interstitial pneumonia with: a diffuse alveolar damage (DAD) component, coupled with microvascular involvement with intra- and extra-vascular fibrin deposition and intravascular trapping of neutrophils, and, frequently, with formation of microthombi in arterioles. Major pulmonary thromboemboli with pulmonary infarcts and/or hemorrhage occurred in 5 of the 23 patients. Two of the Houston cases had interstitial pneumonia with DAD pattern. One of the Houston cases had multiple bilateral segmental pulmonary thromboemboli with infarcts and hemorrhages coupled with, in non-hemorrhagic areas, a distinctive interstitial lymphocytic pneumonitis with intra-alveolar fibrin deposits and no hyaline membranes, possibly representing a transition form to acute fibrinous and organizing pneumonia (AFOP). Multifocal acute injury of cardiac myocytes was frequently observed. Lymphocytic myocarditis was reported in 1 case. In addition to major pulmonary pathology, the three Houston cases had evidence of lymphocytic pericarditis, multifocal acute injury of cardiomyocytes without inflammatory cellular infiltrates, depletion of splenic white pulp, focal hepatocellular degeneration and rare glomerular capillary thrombosis. Each had evidence of chronic cardiac disease: hypertensive left ventricular hypertrophy (420 gram heart), dilated cardiomyopathy (1070 gram heart), and hypertrophic cardiomyopathy (670 gram heart). All three subjects were obese (BMIs of 33.8, 51.65 and 35.2 Kg/m2). Overall, the autopsy findings support the concept that the pathogenesis of severe COVID-19 disease involves direct viral-induced injury of multiple organs, including heart and lungs, coupled with the consequences of a procoagulant state with coagulopathy.


title: Knowledge, attitude, and practices related to standard precautions of surgeons and physicians in university-affiliated hospitals of Shiraz, Iran

text: Summary Objective To measure levels of knowledge, attitudes, and practice toward standard precautions (SP) in medical practitioners of Shiraz University of Medical Sciences affiliated hospitals in Iran. Method In this cross-sectional study, knowledge, attitude, and practice related to SP among four medical staff groups – surgeons, surgical residents, physicians and medical residents – were assessed using a questionnaire. Results Across the four medical staffing groups the median levels of knowledge ranged from 6 to 7 (maximum score 9), median attitude scores were high ranging from 35 to 36 (maximum score 45), while median practice scores were low, ranging from 2 to 3 (maximum score 9). A moderate relationship between knowledge and attitudes was found in surgical residents and medical residents (r =0.397, p =0.030 and r =0.554, p =0.006, respectively). No significant correlation was found between knowledge and practice between the groups. A significant but poor (r =0.399, p =0.029) relationship between attitude and practice was found in surgical residents. Conclusion Specific training programs may have to target newly graduated medical practitioners to establish acceptance of appropriate practices that will enable them to adopt and adhere to SP while their older counterparts may require more intense continuous assistance.


title: Virus detection and cytokine profile in relation to age among acute exacerbations of childhood asthma

text: Abstract Background Little information is available regarding eosinophil activation and cytokine profiles in relation to age in virus-induced bronchial asthma. We therefore explored the association between age, respiratory viruses, serum eosinophil cationic protein (ECP), and cytokines/chemokines in acute exacerbations of childhood asthma. Methods We investigated viruses in nasal secretions from 88 patients with acute exacerbation of childhood asthma by using antigen detection kits and/or RT-PCR, followed by direct DNA sequencing analysis. We also measured peripheral eosinophil counts, and the serum levels of ECP and 27 types of cytokines/chemokines in 71 virus-induced acute asthma cases and 13 controls. Results Viruses were detected in 71(80.7%) of the 88 samples. The three major viruses detected were rhinoviruses, RS viruses, and enteroviruses; enteroviruses were found to be dominant in patients aged ≥3 years. There was no change in the levels of rhinoviruses and RS viruses between the two age groups, defined as children aged <3 years and children aged ≥3 years. Serum concentrations of ECP, IL-5, and IP-10 were significantly elevated in virus-induced acute asthma cases compared with controls. Serum ECP values were significantly higher in patients with virus-induced asthma at age ≥3 years compared with those aged <3 years. Among the 27 cytokines/chemokines, serum IP-10 was significantly higher in virus-induced asthma in patients <3 years than in those ≥3 years. Serum ECP and IL-5 production correlated significantly with age, whereas serum IP-10 showed an inverse correlation with age. Conclusions Age-related differences in cytokine profiles and eosinophil activation may be related to virus-induced acute exacerbations of childhood asthma.


title: Inhibition of SARS-CoV Gene Expression by Adenovirus-Delivered Small Hairpin RNA

text: OBJECTIVE: Severe acute respiratory syndrome (SARS) is a highly contagious and lethal disease caused by a new type of coronavirus, SARS-associated coronavirus (SARS-CoV). Currently, there is no efficient treatment and prevention for this disease. We constructed recombinant adenoviral vectors that can express shRNAs, which inhibited the expression of SARS-CoV genes effectively in mammalian cells. METHODS: In this study, we designed several plasmids that express small hairpin RNA molecules (shRNA) specifically targeting to the genes encoding for the SARS-CoV nucleocapsid (N) protein and envelope (E) protein, respectively. Effective shRNA molecules to the viral genes were screened and identified, and then constructed into adenovirus vectors. The effects of adenovirus-delivered small hairpin RNA on SARS-CoV gene expression were determined by RT-PCR, Western blot, and luciferase activity assays. RESULTS: The levels of viral mRNAs and viral proteins of the targets were significantly decreased or completely inhibited in cell lines after being infected with the recombinant adenoviruses that expressed specific shRNA molecules. CONCLUSIONS: Since many cell types can be efficiently infected by adenovirus, recombinant adenoviruses could serve as an alternative powerful tool for shRNA delivery and for gene suppression, especially when the targeted cells are resistant to transfection by DNA or RNA. With availability of high titers of adenoviruses and uniform and rapid infection, this approach would have foreseeable wide applications both in experimental biology and molecular medicine.


title: Patterns of perception toward influenza pandemic among the front-line responsible health personnel in southern Thailand: a Q methodology approach

text: BACKGROUND: Thailand has joined the World Health Organization effort to prepare against a threat of an influenza pandemic. Regular monitoring on preparedness of health facilities and assessment on perception of the front-line responsible health personnel has never been done. This study aimed to document the patterns of perception of health personnel toward the threat of an influenza pandemic. METHODS: Q methodology was applied to a set of 385 health personnel in charge of influenza pandemic preparedness in the three southernmost provinces of Thailand. Subjects were asked to rank 33 statements about various issues of influenza pandemic according to a pre-designed score sheet having a quasi-normal distribution on a continuous 9-point bipolar scale ranging from -4 for strongly disagree to +4 for strongly agree. The Q factor analysis method was employed to identify patterns based on the similarity and dissimilarity among health personnel. RESULTS: There were three main patterns of perception toward influenza pandemic with moderate correlation coefficients between patterns ranging from 0.37 to 0.55. Pattern I, health personnel, which we labeled pessimistic, perceived themselves as having a low self-efficacy. Pattern II, which we labeled optimistic, perceived the threat to be low severity and low vulnerability. Pattern III, which we labeled mixed, perceived low self-efficacy but low vulnerability. Across the three patterns, almost all the subjects had a high expectancy that execution of recommended measures can mitigate impacts of the threat of an influenza pandemic, particularly on multi-measures with high factor scores of 4 in all patterns. The most conflicting area was vulnerability on the possible impacts of an influenza pandemic, having factor scores of high (3), low (-4), and neutral (0) for patterns I, II, and III, respectively. CONCLUSION: Strong consistent perceptions of response efficacy against an influenza pandemic may suggest a low priority to convince health personnel on the efficacy of the recommended measures. Lack of self-efficacy in certain sub-groups indicates the need for program managers to improve self-confidence of health personnel to participate in an emergency response.


title: Lysine Methylation as a Routine Rescue Strategy for Protein Crystallization

text: Summary Crystallization remains a critical step in X-ray structure determination. Because it is not generally possible to rationally predict crystallization conditions, commercial screens have been developed which sample a wide range of crystallization space. While this approach has proved successful in many cases, a significant number of proteins fail to crystallize despite being soluble and monodispersed. It is established that chemical modification can facilitate the crystallization of otherwise intractable proteins. Here we describe a method for the reductive methylation of lysine residues which is simple, inexpensive, and efficient, and report on its application to ten proteins. We describe the effect of methylation on the physico-chemical properties of these proteins, and show that it led to diffraction-quality crystals from four proteins and structures for three that had hitherto proved refractory to crystallization. The method is suited to both low- and high-throughput laboratories.


title: Airborne route and bad use of ventilation systems as non-negligible factors in SARS-CoV-2 transmission

text: Summary The world is facing a pandemic of unseen proportions caused by a corona virus named SARS-CoV-2 with unprecedent worldwide measures being taken to tackle its contagion. Person-to-person transmission is accepted but WHO only considers aerosol transmission when procedures or support treatments that produce aerosol are performed. However, transmission mechanisms are not fully understood and there is evidence for an airborne route to be considered as the virus remains viable in aerosols for at least 3h and that mask usage was the best intervention to prevent infection. Heating, Ventilating and Air Conditioning Systems (HVAC) are used as a primary infection disease control measure. However, they may contribute to the transmission/spreading of airborne diseases as proposed in the past for SARS. The authors believe that airborne transmission is possible and that HVAC systems when not adequately used may contribute to the transmission of the virus, as suggested by descriptions of from Japan, Germany, and the Diamond Princess Cruise Ship. Previous SARS outbreaks reported at Amoy Gardens, Emergency Rooms and Hotels, for example, also suggested airborne transmission. Further studies are warranted to confirm our hypotheses but the assumption of such way of transmission would cause a major shift in measures recommended to prevent infection such as the disseminated use of masks and structural changes to hospital and other facilities HVAC systems.


KIDS SAVE LIVES: ERC Position statement on schoolteacherś education and qualification in resuscitation


title: in-silica Analysis of SARS-CoV-2 viral strain using Reverse Vaccinology Approach: A Case Study for USA

text: The recent pandemic of COVID19 that has struck the world is yet to be battled by a potential cure. Countless lives have been claimed due to the existing pandemic and the societal normalcy has been damaged permanently. As a result, it becomes crucial for academic researchers in the field of bioinformatics to combat the existing pandemic. The study involved collecting the virulent strain sequence of SARS-nCoV19 for the country USA against human host through publically available bioinformatics databases. Using in-silica analysis and reverse vaccinology, two leader proteins were identified to be potential vaccine candidates for development of a multi-epitope drug. The results of this study can provide further researchers better aspects and direction on developing vaccine and immune responses against COVID19. This work also aims at promoting the use of existing bioinformatics tools to faster streamline the pipeline of vaccine development. The Situation of COVID19 A new infection respiratory disease was first observed in the month of December 2019, in Wuhan, situated in the Hubei province, China. Studies have indicated that the reason of this disease was the emergence of a genetically-novel coronavirus closely related to SARS-CoV. This coronavirus, now named as nCoV-19, is the reason behind the spread of this fatal respiratory disease, now named as COVID-19. The initial group of infections is supposedly linked with the Huanan seafood market, most likely due to animal contact. Eventually, human-to-human interaction occurred and resulted in the transmission of the virus to humans. [13]. Since then, nCoV-19 has been rapidly spreading within China and other parts of World. At the time of writing this article (mid-March 2020), COVID-19 has spread across 146 countries. A count of 164,837 cases have been confirmed of being diagnosed with COVID-19, and a total of 6470 deaths have occurred. The cumulative cases have been depicting a rising trend and the numbers are just increasing. WHO has declared COVID-19 to be a “global health emergency”. [14]. Current Scenario and Objectives Currently, research is being conducted on a massive level to understand the immunology and genetic characteristics of the disease. However, no cure or vaccine of nCoV-19 has been developed at the time of writing this article. Though, nCoV-19 and SARS-CoV are almost genetically similar, the respiratory syndrome caused by both of them, COVID-19 and SARS respectively, are completely different. Studies have indicated that – “SARS was more deadly but much less infectious than COVID-19”. -World Health Organization


title: Cardiovascular Collapse in COVID-19 Infection: The Role of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO)

text: ABSTRACT COVID-19 has been associated with cardiovascular complications including acute cardiac injury, heart failure and cardiogenic shock. The role of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the event of COVID-19-associated cardiovascular collapse has not yet been established. We reviewed existing literature surrounding the role of VA-ECMO in the treatment of coronavirus-related cardiovascular collapse. COVID-19 is associated with higher incidence of cardiovascular complications compared to previous coronavirus outbreaks (SARS-CoV, MERS-CoV). We found only one case report from China where COVID-19-associated fulminant myocarditis and cardiogenic shock (CS) was successfully rescued using VA-ECMO as a bridge to recovery (BTR). We identified potential clinical scenarios (cardiac injury, myocardial infarction with and without obstructive coronary artery disease, viral myocarditis, and decompensated heart failure) leading to CS and risk factors for poor/uncertain benefit (age, sepsis, mixed/predominantly vasodilatory shock, prothrombotic state and/or coagulopathy, severe acute respiratory distress syndrome, multi-organ failure or high-risk prognostic scores) specific to using VA-ECMO as BTR in COVID-19 infection. Additional considerations and proposed recommendations specific to the COVID-19 pandemic were formulated with guidance from published data and expert consensus. A small subset of patients with cardiovascular complications from COVID-19 infection may progress to refractory CS. Accepting that resource scarcity may be the overwhelming concern for healthcare systems during this pandemic, VA-ECMO can be considered in highly selected cases of refractory CS and echocardiographic evidence of biventricular failure. The decision to initiate this therapy should take into consideration availability of resources, perceived benefit as well as risks of transmitting disease.


title: Syndromic surveillance in Vanuatu since Cyclone Pam: a descriptive study

text: In 2012, Vanuatu designed and implemented a syndromic surveillance system based on the guidelines developed by the Pacific Community and the World Health Organization to provide early warning of outbreaks and other important public health events. Four core syndromes were endorsed for surveillance: acute fever and rash, prolonged fever, influenza-like illness and acute watery diarrhoea. In March 2015, Vanuatu was struck by Cyclone Pam, after which several important changes and improvements to the country’s syndromic surveillance were made. To date, there has been no formal evaluation of whether regular reports are occurring or that core syndromes are being documented. We therefore carried out a descriptive study in the 11 sentinel sites in Vanuatu conducting syndromic surveillance between July and December 2015. There was a total of 53 822 consultations which were higher in the first 13 weeks (n = 29 622) compared with the last 13 weeks (n = 24 200). During the six months, there were no cases of acute fever and rash or prolonged fever. There were cases with influenza-like illness from week 27 to 35, but no case was reported after week 35. Acute watery diarrhoea occurred in one or two cases per week during the whole study period. For these two core syndromes, there were generally more females than males, and about one third were children aged under 5 years. In conclusion, Vanuatu implemented changes to its new syndromic surveillance system from July to December 2015, although laboratory components had not yet been incorporated. The laboratory components are working in 2016 and will be the subject of a further report.


title: Structure and interaction with lipid membrane models of Semliki Forest virus fusion peptide

text: Semliki Forest virus (SFV) is a well-characterized alphavirus that infects cells via endocytosis and an acid-triggered fusion step using class II fusion proteins. Membrane fusion is mediated by the viral spike protein, a heterotrimer of two transmembrane subunits, E1 and E2, and a peripheral protein, E3. Sequence analysis of the E1 ectodomain of a number of alphaviruses demonstrated the presence of a highly conserved hydrophobic domain on the E1 ectodomain. This sequence was proposed to be the fusion peptide of SFV and is believed to be the domain of E1 that interacts with the target membrane and triggers fusion. Here, we investigate the structure and the interaction with lipid membrane models of (76)YQCKVYTGVYPFMWGGAYCFC(96) sequence from SFV, named SFV21, using optical method (ellipsometry) and vibrational spectroscopiy approaches (Polarization Modulation infra-Red Reflection Absorption Spectroscopy, PMIRRAS, and polarized ATR-FTIR). We demonstrate a structural flexibility of SFV21 sequence whether the lateral pressure and the lipid environment. In a lipid environment that mimics eukaryotic cell membranes, a conformational transition from an α-helix to a β-sheet is induced in the presence of lipid by increasing the peptide to lipid ratio, which leads to important perturbations in the membrane organisation.


title: Impact of COVID-19 on General Surgical Practice in India

text: The coronavirus disease 2019 (COVID-19) pandemic is a global health crisis, and surgeons are at increased occupational risk of contracting COVID-19. The impact of the disease on prevalent general surgical practice is uncertain and continues to evolve. The study aimed to study the impact of COVID-19 on general surgical practice in India and the future implications of the pandemic. A survey questionnaire was designed and electronically circulated 1 month after India entered a national lockdown during COVID-19 pandemic, amongst members of Indian Association of Gastro-intestinal Endo-surgeons (IAGES), a surgical association with nearly eight thousand members from across the country. Survey questions pertaining to pre-COVID era surgical practices, impact on current practice, and financial implications were asked. Responses were collected and statistically analyzed. One hundred fifty-three surgeons completed the survey, of which only 9.2% were women. Majority (41%) were into practice for more than 20 years; 36.6% were into private practice at multiple hospitals (free-lancers). Amongst the respondents, 41.8% had mainly laparoscopic practice with mean outpatient consultation of 26 patients/day and elective surgeries of 43 cases/month prior to lockdown. Post-lockdown, daily outpatient consults reduced to 4 patients per day, and 77% had not performed a single elective procedure. Hydroxychloroquine (HCQ) chemoprophylaxis was reported by 52% surgeons. Personal protective equipment (PPE) was used by 52% for all cases, while 71.5% stated there are insufficient guidelines for future surgical practice in terms of safety. A drop of more than 75% of their monthly income was experienced by 52% surgeons, while 22% faced 50–75% reduction. One third (33%) of respondents own a hospital and are expecting a monthly financial liability of 2.25 million rupees (nearly 30,000 US dollars). COVID-19 has led to a drastic reduction in outpatient and elective surgical practices. There is a definite need for guidelines regarding safety for future surgical practices and solutions to overcome the financial liabilities in the near future.


title: Hazard Analysis of Critical Control Points Assessment as a Tool to Respond to Emerging Infectious Disease Outbreaks

text: Highly pathogenic avian influenza virus (HPAI) strain H5N1 has had direct and indirect economic impacts arising from direct mortality and control programmes in over 50 countries reporting poultry outbreaks. HPAI H5N1 is now reported as the most widespread and expensive zoonotic disease recorded and continues to pose a global health threat. The aim of this research was to assess the potential of utilising Hazard Analysis of Critical Control Points (HACCP) assessments in providing a framework for a rapid response to emerging infectious disease outbreaks. This novel approach applies a scientific process, widely used in food production systems, to assess risks related to a specific emerging health threat within a known zoonotic disease hotspot. We conducted a HACCP assessment for HPAI viruses within Vietnam’s domestic poultry trade and relate our findings to the existing literature. Our HACCP assessment identified poultry flock isolation, transportation, slaughter, preparation and consumption as critical control points for Vietnam’s domestic poultry trade. Introduction of the preventative measures highlighted through this HACCP evaluation would reduce the risks posed by HPAI viruses and pressure on the national economy. We conclude that this HACCP assessment provides compelling evidence for the future potential that HACCP analyses could play in initiating a rapid response to emerging infectious diseases.


title: Functional Consequences Following Infection of the Olfactory System by Intranasal Infusion of the Olfactory Bulb Line Varient (OBLV) of Mouse Hepatitis Strain JHM

text: The present study assessed the functional consequences of viral infection with a neurotropic coronavirus, designated MHV OBLV, that specifically targets central olfactory structures. Using standard operant techniques and a `go, no-go' successive discrimination paradigm, six BALB/c mice were trained to discriminate between the presentation of an air or odor stimulus (three mice for each of the odorants propanol and propyl acetate). Two additional BALB/c mice were trained to discriminate between the presentation of air and the presentation of either vanillin or propionic acid. Following criterion performance, each mouse received an additional 2000 trials of overtraining. At completion of overtraining one mouse from the propanol and propyl acetate groups were allocated as untreated. The remaining six mice were inoculated with 300 μl of the OBLV stock per nostril for a total of 1.5 × 10(6) p.f.u. in 600 μl. Following a 1 month rest, untreated and inoculated animals were again tested on their respective air versus odor discrimination task. Untreated animals immediately performed at criterion levels. In contrast, inoculated animals varied in their capacity to discriminate between air and odorant. Five of the six inoculated mice showed massive disruption of the olfactory bulb, including death of mitral cells; the other was more modestly affected. In addition, the density of innervation of the olfactory mucosa by substance P-containing trigeminal fibers is also affected by inoculation. Those mice that remained anosmic to the training odorants had the most severe reduction in mitral cell number and substance P fiber density among the inoculated animals.


title: Search for potential target site of nucleocapsid gene for the design of an epitope-based SARS DNA vaccine

text: Abstract It is believed today that nucleocapsid protein (N) of severe acute respiratory syndrome (SARS)-CoV is one of the most promising antigen candidates for vaccine design. In this study, three fragments [N1 (residues: 1–422); N2 (residues: 1–109); N3 (residues: 110–422)] of N protein of SARS-CoV were expressed in Escherichia coli and analyzed by pooled sera of convalescence phase of SARS patients. Three gene fragments [N1 (1–1269 nt), N2 (1–327 nt) and N3 (328–1269 nt)—expressing the same proteins of N1, N2 and N3, respectively] of SARS-N were cloned into pVAX-1 and used to immunize BALB/c mice by electroporation. Humoral (by enzyme-linked immunosorbent assay, ELISA) and cellular (by cell proliferation and CD4+:CD8+ assay) immunity was detected by using recombinant N1 and N3 specific antigen. Results showed that N1 and N3 fragments of N protein expressed by E. coli were able to react with sera of SARS patients but N2 could not. Specific humoral and cellular immunity in mice could be induced significantly by inoculating SARS-CoV N1 and N3 DNA vaccine. In addition, the immune response levels in N3 were significantly higher for antibody responses (IgG and IgG1 but not IgG2a) and cell proliferation but not in CD4+:CD8+ assay compared to N1 vaccine. The identification of antigenic N protein fragments has implications to provide basic information for the design of DNA vaccine against SARS-CoV. The present results not only suggest that DNA immunization with pVax-N3 could be used as potential DNA vaccination approaches to induce antibody in BALB/c mice, but also illustrates that gene immunization with these SARS DNA vaccines can generate different immune responses.


title: Quantitation, biological and physicochemical properties of cell culture-adapted porcine epidemic diarrhea coronavirus (PEDV)

text: Abstract The porcine epidemic coronavirus (PEDV), tentatively classified as a coronavirus, was adapted to Vero cells and a plaque test developed for infectivity titration, allowing us to test the biological and biophysical properties of the virus. Growth kinetics showed peak titers of 105.5 plaque-forming units ml−1 15 h after infection. Filtration experiments and electron microscopy revealed a particle diameter between 100 and 200 nm. The bouyant density of the virus was 1.18. The particle lost its infectivity on treatment with lipid solvents. Virus replication could not be inhibited by 5-iodo-2′-deoxyuridine. PEDV was moderately stable at 50°C, but heat sensitivity was not altered by divalent cations. At 4°C, the virus was stable between pH 5.0 and 9.0, but at 37°C stability was restricted to the pH range 6.5–7.5. Viral infectivity was not impaired by ultrasonication or by multiple freezing and thawing. PEDV was not neutralized by transmissible gastroenteritis virus antiserum. On the basis of the tests carried out, PEDV is a pleomorphic, enveloped RNA virus with a particle diameter of ∼ 150 nm and a bouyant density of 1.18. Infectivity depends on the presence of trypsin, and infected cells show a tendency to fuse and to form syncytia. All of these properties, as well as its physicochemical characteristics, allow PEDV to be classified as a coronavirus.


title: Immunodominant viral peptides as determinants of cross-reactivity in the immune system – Can we develop wide spectrum viral vaccines?

text: Summary When we look back to Edward Jenner vaccination of a young man in 1796, we cannot help thinking that he was both lucky and crazy. Crazy because he decided to test in a human being a hypothesis based mainly in the traditional belief that people who had acquired cowpox from the udders of a cow were thereafter resistant to smallpox, a quite devastating disease, and lucky because (even considering that he did not know this at that time) he succeeded to induce protection against a pathogen through the induction of an immune response directed against a different agent. Not only was he able to protect the young man but he took the first step towards the development of a vast new field, vaccination. It is acceptable to say that Jenner was lucky because he succeeded in promoting protection against smallpox using a cowpox virus and this induction of protection in a cross-reactive way is believed to be quite rare. Nevertheless, more and more examples of cross-reactive immune responses are being described and we are beginning to admit that cross-reactivity is far more common and important than we used to think. Here we review cross-reactivity in the immune system and the plasticity of T cell recognition. Based on the existence of T cell receptor promiscuous recognition and cross-recognition of conserved viral immunodominant epitopes, we propose two approaches to develop wide spectrum viral vaccines. The first one is based on the identification, characterization, and cloning of immunodominant viral epitopes able to stimulate responses against different viruses. The produced peptides could then be purified and serve as a basis for vaccine therapies. A second strategy is based on the identification of conserved patterns in immunodominant viral peptides and the production of synthetic peptides containing the amino acid residues necessary for MHC anchoring and TCR contact. Although we are still far from a complete knowledge of the cross-reactivity phenomenon in the immune system, the analysis of immunodominant viral epitopes and the identification of particular “viral patterns” seems to be important steps towards the development of wide spectrum viral vaccines.


title: Human β-defensin 2 is involved in CCR2-mediated Nod2 signal transduction, leading to activation of the innate immune response in macrophages

text: Abstract Beta-defensins contribute to host innate defense against various pathogens, including viruses, although the details of their roles in innate immune cells are unclear. We previously reported that human β-defensin 2 (HBD 2) activates primary innate immunity against viral infection and suggested that it plays a role in the induction of the adaptive immune response. We analyzed the mechanisms by which HBD 2 primes innate antiviral immunity and polarized activation of macrophage-like THP-1 cells using the receptor-binding domain (RBD) of Middle East respiratory syndrome coronavirus (MERS-CoV) spike protein (S RBD) as a model antigen. The expression of nucleotide-binding oligomerization domain containing 2 (Nod2), type I interferons, (IFNs), and proinflammatory mediators was enhanced in S RBD-HBD 2-treated THP-1 cells. S RBD-HBD 2 treatment also enhanced phosphorylation and activation of receptor-interacting serine/threonine-protein kinase 2 and IFN regulatory factor 3 compared to S RBD alone. Finally, HBD 2-conjugated S RBD interacted with C-C chemokine receptor 2 (CCR2), and Nod2 was involved in HBD 2-mediated CCR2 signaling, which was associated with the activation and M1 polarization of THP-1 cells. Therefore, HBD 2 promotes CCR2-mediated Nod2 signaling, which induces production of type I IFNs and an inflammatory response, and enhances primary innate immunity leading to an effective adaptive immune response to HBD 2-conjugated antigen.


title: Wastewater surveillance for population-wide Covid-19: The present and future

text: Abstract The Covid-19 pandemic (Coronavirus disease 2019) continues to expose countless unanticipated problems at all levels of the world's complex, interconnected society — global domino effects involving public health and safety, accessible health care, food security, stability of economies and financial institutions, and even the viability of democracies. These problems pose immense challenges that can voraciously consume human and capital resources. Tracking the initiation, spread, and changing trends of Covid-19 at population-wide scales is one of the most daunting challenges, especially the urgent need to map the distribution and magnitude of Covid-19 in near real-time. Other than pre-exposure prophylaxis or therapeutic treatments, the most important tool is the ability to quickly identify infected individuals. The mainstay approach for epidemics has long involved the large-scale application of diagnostic testing at the individual case level. However, this approach faces overwhelming challenges in providing fast surveys of large populations. An epidemiological tool developed and refined by environmental scientists over the last 20 years (Wastewater-Based Epidemiology — WBE) holds the potential as a key tool in containing and mitigating Covid-19 outbreaks while also minimizing domino effects such as unnecessarily long stay-at-home policies that stress humans and economies alike. WBE measures chemical signatures in sewage, such as fragment biomarkers from the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), simply by applying the type of clinical diagnostic testing (designed for individuals) to the collective signature of entire communities. As such, it could rapidly establish the presence of Covid-19 infections across an entire community. Surprisingly, this tool has not been widely embraced by epidemiologists or public health officials. Presented is an overview of why and how governments should exercise prudence and begin evaluating WBE and coordinating development of a standardized WBE methodology — one that could be deployed within nationalized monitoring networks to provide intercomparable data across nations.


title: Skin Signs of Systemic Disease in Childhood

text: Several systemic disorders of childhood are characterized by cutaneous stigmata, and these skin signs can serve as important diagnostic clues. Many of the systemic illnesses that are seen in both the pediatric and adult populations often manifest in different ways with respect to their cutaneous features. Also, there are conditions that uniquely present in childhood, such as KD, HSP, acute hemmorhagic edema of infancy, and NOMID. Early recognition of these disorders is important for initiation of appropriate therapy and prevention of adverse outcomes.


Information Typology in Coronavirus (COVID-19) Crisis; a Commentary


title: Impact of coronavirus (COVID‐19) on otolaryngologic surgery: Brief commentary

text: BACKGROUND: The Coronavirus disease—2019 (COVID‐19) pandemic is a global health crisis and otolaryngologists are at increased occupational risk of contracting COVID‐19. There are currently no uniform best‐practice recommendations for otolaryngologic surgery in the setting of COVID‐19. METHODS: We reviewed relevant publications and position statements regarding the management of otolaryngology patients in the setting of COVID‐19. Recommendations regarding clinical practice during the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks were also reviewed. RESULTS: Enhanced personal protective equipment (N95 respirator and face shield or powered air‐purifying respirator, disposable cap and gown, gloves) is required for any otolaryngology patient with unknown, suspected, or positive COVID‐19 status. Elective procedures should be postponed indefinitely, and clinical practice should be limited to patients with urgent or emergent needs. CONCLUSION: We summarize current best‐practice recommendations for otolaryngologists to ensure safety for themselves, their clinical staff, and their patients.


title: Solvent/detergent plasma: pharmaceutical characteristics and clinical experience

text: The solvent/detergent treatment is an established virus inactivation technology that has been industrially applied for manufacturing plasma derived medicinal products for almost 30 years. Solvent/detergent plasma is a pharmaceutical product with standardised content of clotting factors, devoid of antibodies implicated in transfusion-related acute lung injury pathogenesis, and with a very high level of decontamination from transfusion-transmissible infectious agents. Many clinical studies have confirmed its safety and efficacy in the setting of congenital as well as acquired bleeding disorders. This narrative review will focus on the pharmaceutical characteristics of solvent/detergent plasma and the clinical experience with this blood product.


title: Tackling animal diseases to protect human health: As veterinary science celebrates cattle plague eradication, the inextricable link between human, animal and ecosystem health is increasingly appreciated

text: Veterinary research is gaining in importance not only because of the economic impact of animal diseases, but also because animals are a fertile reservoir of zoonoses; pathogens that could jump the species barrier and infect humans.


title: Model-based estimation of the link between the daily survival probability and a time-varying covariate, application to mosquitofish survival data

text: Abstract The survival probability in a group of individuals may evolve in time due to the influence of a time-varying covariate. In this paper we present a model-based approach allowing the estimation of the functional link between the survival probability and a time-varying covariate when data are grouped and time-period censored. The approach is based on an underlying model consisting in non-stationary Markov processes and describing the survival of individuals. The underlying model is aggregated in time and at the group level to handle the group structure of data and the censoring. The aggregation yields a generalized non-linear mixed model. Then, a Bayesian procedure allows the estimation of the model parameters and the description of the link between the survival probability and the time-varying covariate. This approach is applied in order to explore the relationship between the daily survival probability of mosquitofish (Gambusia holbrooki) and their time-varying lengths (small mosquitofish die with a higher rate than large ones because they are more affected by predation, cannibalism and environmental stress).


title: Detection of feline infectious peritonitis virus infection in cell cultures and peripheral blood mononuclear leukocytes of experimentally infected cats using a biotinylated cDNA probe

text: Abstract A dot blot hybridization assay, using a biotinylated cDNA probe, was able to detect feline infectious peritonitis virus (FIPV) RNA in Felis catus whole fetus (fcwf-4) cells infected with the FIPV isolates DF2, 79-1146, UCDI, and UCD2. The probe cross-hybridized in the dot blot assay with nucleic acid of a closely related feline coronavirus, feline enteric coronavirus (FECV)-79-1683. To construct the probe, a 2.5 kilobase cDNA, prepared from FIPV-DF2 genomic RNA, was molecularly cloned. The recombinant cDNA clone was digested with the restriction endonuclease Rsa I, and an 870 basepair Rsa I fragment was isolated from vector DNA by agarose electrophoresis and glassmilk purification. This fragment was complementary to the 3′ three fourths of the nucleocapsid gene. The hybridization probe was prepared by random primed labeling in the presence of biotin-11-dUTP. Using an avidin-alkaline phosphatase conjugate and chemiluminescent substrate detection system, virus could be detected in as few as 3000 infected cells. In an in vivo study, the probe was used to detect FIPV RNA in peripheral blood mononuclear leukocytes (PBML) isolated at various post-infection days (PID) from cats experimentally infected with the FIP-producing coronavirus isolate FIPV-79-1146 or FIPV-DF2. Viral RNA could be detected in as few as 12 000 PBML isolated from cats at PID 7 and in 50 000 PBML at PID 22. There was no consistent pattern, however, between hybridization results and prognosis or severity of disease at the time of sampling. Despite some cross-hybridization with FECV RNA, this probe should be useful for diagnosis of FIP, because cats infected with FECV most likely do not become viremic.


title: Compensating for the ‘Authoritarian Advantage’ in Crisis Response: A Comparative Case Study of SARS Pandemic Responses in China and Taiwan

text: Why do some countries more effectively respond to crises than others? This paper compares China’s relatively effective response to the 2002–3 SARS outbreak with Taiwan’s relatively ineffective response, focusing on three variables that constitute China’s ‘authoritarian advantage’ - centralized decision making powers; public support; and, relations with the mass media. The paper rejects a fourth explanatory variable specific to the Taiwan case – membership in international organizations. Drawing heavily on the Taiwan example, the paper concludes by suggesting options for overcoming the authoritarian advantage in pandemic response.


title: Surface Alterations to Impart Antiviral Properties to Combat COVID-19 Transmission

text: A global epidemic caused by highly transmittable COVID-19 is causing severe loss of human life. In this study, two aspects of reducing transmission of COVID-19 virus, due to surface contact, are discussed: first refers to the effect of nanocarbon fullerene C(60) coating on surface, that causes lipid peroxidation on the phospholipid layer present in the outer envelope of COVID-19; the second aspect refers to creating hydrophobic surfaces by texturing them, so that the contact area between virus and surface is minimized due to the presence of entrapped air between the topographies. These can be similar to micro-/nano-multiscale textured surfaces that have anti-biofouling properties. Fullerene-coated surfaces can be seen as a possible solution to decrease the adhesion of virus on the surface, as they will be hydrophobic as well as toxic to the envelope.


title: The Covid‐19 pandemic

text: Statistics, statistical concepts and perspectives


title: The Utility of Data Transformation for Alignment, De Novo Assembly and Classification of Short Read Virus Sequences

text: Advances in DNA sequencing technology are facilitating genomic analyses of unprecedented scope and scale, widening the gap between our abilities to generate and fully exploit biological sequence data. Comparable analytical challenges are encountered in other data-intensive fields involving sequential data, such as signal processing, in which dimensionality reduction (i.e., compression) methods are routinely used to lessen the computational burden of analyses. In this work, we explored the application of dimensionality reduction methods to numerically represent high-throughput sequence data for three important biological applications of virus sequence data: reference-based mapping, short sequence classification and de novo assembly. Leveraging highly compressed sequence transformations to accelerate sequence comparison, our approach yielded comparable accuracy to existing approaches, further demonstrating its suitability for sequences originating from diverse virus populations. We assessed the application of our methodology using both synthetic and real viral pathogen sequences. Our results show that the use of highly compressed sequence approximations can provide accurate results, with analytical performance retained and even enhanced through appropriate dimensionality reduction of sequence data.


title: Cloning and sequence analysis of the N gene of porcine epidemic diarrhea virus LJB/03

text: The nucleocapsid (N) gene of the porcine epidemic diarrhea virus (PEDV) strain LJB/03 which was previously isolated in Heilongjiang province, China, was cloned, sequenced and compared with published sequences of other avian and mammalian coronavirus. The nucleotide sequence encoding the entire N gene open reading frame (ORF) of LJB/03 was 1326 bases long and encoded a protein of 441 amino acids with predicted Mr of 49 kDa. It consisted of 405 adenines (30.5%), 294 cytosines (22.1%), 329 guanines (24.8%) and 298 thymines (22.5%) residues. Sequence comparison with other PEDV strains selected from GenBank revealed that the LJB/03 N gene has a high sequence homology to those of other PEDV isolates, 97.4% with JS2004, 95.6% with chinju99, 96.6% with Br1/87, and 96.8% with CV777. The encoded protein shared 96.4% amino acid identities compared with CV777, 96.1% with Brl/87, 98% with JS2004, 96.90% with chinju99, respectively. The amino acid sequence contained seven potential protein kinase C phosphorylation sites, nine Casein kinase II phosphorylation sites, one Tyrosine kinase phosphorylation site, two cAMP- and cGMP-dependent protein kinase phosphorylation sites.


title: Coronavirus Disease 2019 Pandemic: Health System and Community Response to a Text Message (Text4Hope) Program Supporting Mental Health in Alberta

text: In an effort to support the mental health of Albertans during the coronavirus disease 2019 (COVID-19) pandemic, Alberta Health Services launched a supportive text message (Text4Mood) program on March 23, 2020. The program was simultaneously approved for funding by the 6 regional health foundations and launched within 1 week of conception. Residents of Alberta can subscribe to the program by texting “COVID19HOPE” to a sort code number. Each subscriber receives free daily supportive text messages, for 3 months, crafted by a team of clinical psychologists, psychiatrists, mental health therapist, and mental health service users. Within 1 week of the launch of Text4Hope, 32 805 subscribers had signed up to the program, and there have been expressions of interests from other jurisdictions to implement a similar program to support the mental health of those in quarantine, isolation, or lockdown.


title: Crystal structure of an acetyl esterase complexed with acetate ion provides insights into the catalytic mechanism

text: Abstract We previously reported the crystal structure of an acetyl esterase (TcAE206) belonging to carbohydrate esterase family 3 from Talaromyces cellulolyticus. In this study, we solved the crystal structure of an S10A mutant of TcAE206 complexed with an acetate ion. The acetate ion was stabilized by three hydrogen bonds in the oxyanion hole instead of a water molecule as in the structure of wild-type TcAE206. Furthermore, the catalytic triad residue His182 moved 0.8 Å toward the acetate ion upon substrate entering the active site, suggesting that this movement is necessary for completion of the catalytic reaction.


title: Incidence and Clinical Course of Respiratory Viral Coinfections in Children Aged 0–59 Months

text: Clinical data available on coinfections are contradictory concerning both the number of viruses involved and the severity of the condition. A total of 114 patients aged 0–59 months with symptoms of respiratory tract infection were enrolled into the study. Nasal and pharyngeal swabs were tested using the PCR method for the following 12 viruses: influenza A, influenza B, respiratory syncytial virus A (RSV A), respiratory syncytial virus B (RSV B), adenovirus, metapneumovirus, coronavirus 229E/NL63 (hCoV229), coronavirus OC43 (hCoVOC43), parainfluenza virus 1 (PIV-1), parainfluenza virus 2 (PIV-2), parainfluenza virus 3 (PIV-3), and rhinovirus A/B. Coinfections were detected in nine (8 %) patients. Five of the coinfections were related to influenza A (H3N2) virus associated with the following other, single or combined, respiratory viruses: influenza B in one case, hCoV229 in two cases, hCoV229, RSV A, and PIV-2 in one case, and PIV-1, PIV-2, RSV A, RSV B, and adenovirus in one case. The other four coinfections were caused by: adenovirus and hCoVOC43, adenovirus, and rhinovirus, RSV A and PIV-1, influenza B, and RSV B. We did not observe any significant differences in the clinical course of infections caused either by a single or multiple viral factors.


title: Associations among state‐level physical distancing measures and suicidal thoughts and behaviors among U.S. adults during the early COVID‐19 pandemic

text: PURPOSE: The purpose of this study was to identify leading sources of stress, describe rates of mental health outcomes, and examine their associations among U.S. adults during the first months of the COVID‐19 pandemic. METHOD: In a cross‐sectional, general population survey conducted from March 18 to April 4, 2020, U.S. adults (n=10,625) were recruited through Qualtrics Panels using quota sampling methods. RESULTS: Life stressors, probable depression, past‐month suicide ideation, and past‐month suicide attempts were not elevated among participants subject to state‐level stay‐at‐home orders and/or large gatherings bans. Multiple life stressors were associated with increased rates of probable depression. Past‐month suicide ideation was significantly higher among participants reporting ongoing arguments with a partner and serious legal problems. Past‐month suicide attempt was significantly higher among participants reporting concerns about a life‐threatening illness or injury, but was significantly lower among participants reporting an unexpected bill or expense. CONCLUSIONS: Results failed to support the conclusion that physical distancing measures are correlated with worse mental health outcomes. Concerns about life‐threatening illness or injury was uniquely associated with increased risk of suicide attempt.


title: Articles: Seroprevalence study of Feline Coronavirus in owned and feral cats in Sydney, Australia

text: Objectives To establish the seroprevalence of Feline Coronavirus (FCoV) infection in two defined groups of cats in Sydney: owned and feral cats; ii) to identify factors associated with an increased risk of infection with FCoV; and iii) to establish the seroprevalence and FCoV antibody titres of owned cats with immunohistochemically confirmed feline infectious peritonitis (FIP). Design Prospective multi‐institutional cross sectional study. Procedure Serum samples from owned cats presented to three inner city veterinary clinics in Sydney and feral cats from a colony in South Western Sydney over an 11‐month period were tested for FCoV antibodies using the Immunocomb test kit. The relationship between serological score and six major factors (breed, age, gender, number of cats per household, living environment and health status) in the owned cat sample population was analysed and compared to cats with FIP. Results The seroprevalence of FCoV infection in the sample population of owned and feral cats was 34% and 0%, respectively. The median Immunocomb scores of DSH, Persian, Siamese and Devon Rex cats were significantly lower than that of Burmese, BSH, Abyssinian, Birman, Ragdoll and Russian Blue. The median Immunocomb score of pedigree cats less than 2 years‐of‐age was significantly higher than for pedigree cats greater than 2 years‐of‐age. This distinction was not evident in DSH cats in these age groups. The number of cats per household at the time of blood collection had a strong positive association with Immunocomb score. The median Immunocomb score of cats with immunohistochemically confirmed FIP was significantly higher than cats in the sample population of owned cats but there was sufficient overlap between these two groups to make definitive diagnosis of FIP by serology impossible. Conclusion This represents the first seroprevalence study of FCoV in Australia. The major determinants of antibody score of owned cats identified in this study were breed, age and the number of cats per household. The significant relationship between the breed of the cat and the FCoV antibody titre further supports the notion, proposed previously by the authors, that breed related differences exist in the immunological response to FCoV infection.


title: Chapter 2 Cybercrime in cloud Risks and responses in Hong Kong, Singapore

text: Abstract The popularity and commercialization of the “Internetwork” began in the late 1990s through the interconnection of computer networks using special gateways or routers to transfer packets of electronic data. As with many things in life, Internetwork technology has had both positive and negative effects on society, and Asia has been no exception. One of the negative effects has been a surge in Internet crime. According to a report released by the Gartner Consulting Group, in 2013 smart phone sales exceeded regular phone sales for the first time, with 968 million smart phones sold, representing 54% of the global mobile phone total and an increase of 54% from 2012. The popularity and technology of the mobile Internetwork, especially the smart mobile phone web, has changed the Internetwork landscape through the concept of cloud computing. Cloud computing is distributed computing over a network, using a program or application that can run on many connected computers and in different locations around the globe simultaneously at a reduced cost. This distributed cloud computing presents law enforcement authorities with the unique challenge of policing Internet crime. Cloud computing relies on sharing resources to achieve coherence, and in doing so creates economies of scale for converged infrastructures and shared services. Accordingly, one problem facing the authorities is the presence of trans- and multijurisdictional crimes. In this chapter, I explore this topic in the contexts of Hong Kong and Singapore, as both are key players on the international stage, especially in relation to international finance and information technology. In both locations, infrastructure works to maintain global financial center status. The remainder of this chapter is organized as follows. A brief overview of the development of cloud computing is followed by an examination of cybercrime risks in the cloud. Then, I review how the authorities in Hong Kong and Singapore respond to cybercrime risks and explore the current government policies on cloud computing, particularly in fighting cybercrime.


title: Increase in Methicillin-Resistant Staphylococcus aureus Acquisition Rate and Change in Pathogen Pattern Associated with an Outbreak of Severe Acute Respiratory Syndrome

text: Background. An outbreak of severe acute respiratory syndrome (SARS) occurred in our 22-bed intensive care unit (ICU; Prince of Wales Hospital, Hong Kong, HKSAR, China) from 12 March to 31 May 2003, when only patients with SARS were admitted. This period was characterized by the upgrading of infection control precautions, which included the wearing of gloves and gowns all the time, an extensive use of steroids, and a change in antibiotic prescribing practices. The pattern of endemic pathogenic organisms, the rates of acquisition of methicillin-resistant Staphylococcus aureus (MRSA), and the rates of ventilator-associated pneumonia (VAP) were compared with those of the pre-SARS and post-SARS periods. Methods. Data on pathogenic isolates were obtained from the microbiology department (Prince of Wales Hospital). Data on MRSA acquisition and VAP rates were collected prospectively. MRSA screening was performed for all ICU patients. A case of MRSA carriage was defined as an instance in which MRSA was recovered from any site in a patient, and cases were classified as imported or ICU-acquired if the first MRSA isolate was recovered within 72 h of ICU admission or after 72 h in the ICU, respectively. Results. During the SARS period in the ICU, there was an increase in the rate of isolation of MRSA and Stenotrophomonas and Candida species but a disappearance of Pseudomonas and Klebsiella species. The MRSA acquisition rate was also increased: it was 3.53% (3.53 cases per 100 admissions) during the pre-SARS period, 25.30% during the SARS period, and 2.21% during the post-SARS period (P < .001). The VAP rate was high, at 36.5 episodes per 1000 ventilator-days, and 47% of episodes were caused by MRSA. Conclusions. A SARS outbreak in the ICU led to changes in the pathogen pattern and the MRSA acquisition rate. The data suggest that MRSA cross-transmission may be increased if gloves and gowns are worn all the time.


title: Can dapagliflozin have a protective effect against COVID-19 infection? A hypothesis

text: Abstract It has been reported that frequent occurrence of COVID-19 infection in these patients is associated with low cytosolic pH. During virus infection, serum lactate dehydrogenase (LDH) level excessively rises. LDH is a cytosolic enzyme and the serum level increases as the cell break down. When anaerobic conditions develop, lactate formation increases from pyruvate. Cell pH is regulated by very complex mechanisms. When lactate increases in the extracellular area, this symporter carries lactate and H+ ion into the cell, and the intracellular pH quickly becomes acidic. Paradoxically, Na+/H+ exchanger activation takes place. While H+ ion is thrown out of the cell, Na+ and Ca+2 enter the cell. When Na+ and Ca+2 increase in the cell, the cells swell and die. Dapagliflozin is a sodium-glucose cotransporter-2 inhibitor. Dapagliflozin has been reported to reduce lactate levels by various mechanisms. Also, it reduces oxygen consumption in tissues and causes the use of glucose in the aerobic pathway, thereby reducing lactate production. A lactate decrease in the environment reduces the activation of lactate/H+ symporter. Thus, the H ion pumping into the cell by this symporter is reduced and the cytosolic pH is maintained. Dapagliflozin also directly inhibits NHE. Thus, Na+ and Ca+2 flow to the cell are inhibited. Dapagliflozin provides the continuation of the structure and functions of the cells. Dapagliflozin can prevent the severe course of COVID-19 infection by preventing the lowering of cytosolic pH and reducing the viral load.