title: Respiratory Virus Infections in People Over 14 Years of Age in Poland in the Epidemic Season of 2017/18

text: People most at risk of influenza complications are the elderly with impaired immunity. Clinical picture of influenza virus infection includes symptoms such as chills, increased body temperature, dry cough, chest pain, or dizziness as well as headaches and muscle aches. In the diagnosis of influenza, quick and effective tests are necessary. Sensitive diagnostic methods of molecular biology require more time, but the result firmly confirm or exclude the presence of the genetic material of influenza or other respiratory viruses. Influenza vaccination plays an important role in combating influenza infection. Unfortunately, the awareness of vaccination benefits is insufficient in Poland. In this study we demonstrate the results of examination of 4,507 people aged over 14 years toward the influenza infection in the epidemic season of 2017/18. Most of the confirmed infections were reported in older people aged over 65, a high-risk population group. A low percentage of the vaccinated population may affect an increased number of confirmed influenza viruses in the elderly. The findings demonstrate a need to increase awareness of vaccination benefits, which is particularly essential to avoid influenza infection in the elderly.


title: A spatio-temporal analysis for exploring the effect of temperature on COVID-19 early evolution in Spain

text: Abstract The new SARS-CoV-2 coronavirus, which causes the COVID-19 disease, was reported in Wuhan, China, in December 2019. This new pathogen has spread rapidly around more than 200 countries, in which Spain has one of the world's highest mortality rates so far. Previous studies have supported an epidemiological hypothesis that weather conditions may affect the survival and spread of droplet-mediated viral diseases. However, some contradictory studies have also been reported in the same research line. In addition, many of these studies have been performed considering only meteorological factors, which can limit the reliability of the results. Herein, we report a spatio-temporal analysis for exploring the effect of daily temperature (mean, minimum and maximum) on the accumulated number of COVID-19 cases in the provinces of Spain. Non-meteorological factors such as population density, population by age, number of travellers and number of companies have also been considered for the analysis. No evidence suggesting a reduction in COVID-19 cases at warmer mean, minimum and maximum temperatures has been found. Nevertheless, these results need to be interpreted cautiously given the existing uncertainty about COVID-19 data, and should not be extrapolated to temperature ranges other than those analysed here for the early evolution period.


title: A signal-flexible gene diagnostic strategy coupling loop-mediated isothermal amplification with hybridization chain reaction

text: Abstract Recent study proves that the combination of loop mediated isothermal nucleic acid amplification (LAMP) with one-step strand displacement (OSD) is of great help to improve the sequence specificity during genetic detection. However, because OSD is incapable of signal amplification, the signal-to-noise ratio or the observable signal change may be usually not significant enough to satisfy practical usage. With the purpose to overcome this challenge, herein a more advanced and practical sensing principle is developed with the OSD replaced by an amplifiable nucleic acid circuit, hybridization chain reaction (HCR). The very contagious norovirus (NoV) was employed as the model target. Compared with LAMP-OSD, the LAMP-HCR can detect as few as 30 copies of NoV gene in 2% fecal samples with significantly enlarged signal change and signal-to-background ratio. Therefore, more reliable detection is achieved. Moreover, due to the high compatibility of HCR, the final LAMP-HCR products can be flexibly transduced into different types of readouts, including fluorescence, flow cytometer (FCM) and even a personal glucose meter (PGM). This further enlarges the operating environments for the detection from hospital labs, bedsides, to potential off-the-shelf devices in local pharmacies. Especially when using FCM or PGM, with the assistance of magnetic beads (MBs), the detection shows even higher tolerance capability to complicated biological matrices.


title: OTITIS MEDIA AGUDA. DIAGNÓSTICO Y MANEJO PRÁCTICO

text: RESUMEN La otitis media aguda es una patología infecciosa del oído medio muy frecuente. El diagnóstico es clínico, por lo que es fundamental un acucioso examen físico y una neumootoscopía para evaluar la movilidad timpánica. Hay dos tendencias respecto al manejo, tratamiento antibiótico inmediato u observación estricta (dependiendo de las características del paciente y del cuadro clínico). Los gérmenes más frecuentes son los virus, Neumococo, Haemophilus influenza y Moraxella catarrhalis. La prevalencia de cada uno de ellos varía según región geográfica y según la presencia de vacunación. La resistencia a antibióticos ha ido en aumento en estos años, pero aún puede considerarse sensible a amoxicilina por lo que se recomienda su uso como primera línea. En el caso de fracaso a tratamiento pueden utilizarse asociaciones con B-lactámicos y/o cefalosporinas, dejando en forma excepcional clindamicina o quinolonas. Aquellos niños con OMA recurrente requerirán evaluación por especialidad para mayor estudio y tratamiento. SUMMARY Acute otitis media is a very frequent cause of medical visit and antimicrobial use in children. Clinical diagnosis should be performed with pneumatic otoscopy. Management of AOM requires a thorough clinical exam and updated knowledge of local patterns of microorganisms involved and antimicrobial susceptibility profiles, knowing that the presence of these microorganisms in AOM transtimpanic exudate cultures may vary depending on geographical areas and vaccination. AOM can be treated either with inmediate antibiotic or with observation depending on patients and clinical characteristics. The most common microorganism causing AOM are Pneumococcus, Haemophilus Influenzae, and Moraxella catarrhalis. S. pneumoniae has acquired resistance to penicillin in the last decade that cannot be extrapolated to Amoxicillin. Based on this data Amoxicillin is recommended as the first choice. For amoxicillin failure, cefalosporins or B lactamase can be prescribed. Patients that presents with recurrent AOM should be refered to otolaryngologist for further evaluation and treatment.


title: Household transmission of respiratory viruses – assessment of viral, individual and household characteristics in a population study of healthy Australian adults

text: BACKGROUND: Household transmission of influenza-like illness (ILI) may vary with viral and demographic characteristics. We examined the effect of these factors in a population-based sample of adults with ILI. METHODS: We conducted a prospective cohort study in community-dwelling Australian adults nested within an influenza vaccine effectiveness trial. On presentation with ILI, participants were swabbed for a range of respiratory viruses and asked to return a questionnaire collecting details of household members with or without similar symptoms. We used logistic and Poisson regression to assess the key characteristics of household transmission. RESULTS: 258 participants from multi-occupancy households experienced 279 ILI episodes and returned a questionnaire. Of these, 183 were the primary case in the household allowing assessment of factors associated with transmission. Transmission was significantly associated in univariate analyses with female sex (27% vs. 13%, risk ratio (RR) = 2.13 (1.08, 4.21)) and the presence of a child in the house (33% vs. 17%, RR = 1.90 (1.11, 3.26)). The secondary household attack proportion (SHAP) was 0.14, higher if influenza was isolated (RR = 2.1 (1.0, 4.5)). Vaccinated participants who nonetheless became infected with influenza had a higher SHAP (Incidence RR = 5.24 (2.17, 12.6)). CONCLUSIONS: The increased SHAP in households of vaccinated participants who nonetheless had confirmed influenza infection supports the hypothesis that in years of vaccine mismatch, not only is influenza vaccine less protective for the vaccine recipient, but that the population’s immunity is also lower.


title: Evolving epidemiology and transmission dynamics of coronavirus disease 2019 outside Hubei province, China: a descriptive and modelling study

text: BACKGROUND: The coronavirus disease 2019 (COVID-19) epidemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began in Wuhan city, Hubei province, in December, 2019, and has spread throughout China. Understanding the evolving epidemiology and transmission dynamics of the outbreak beyond Hubei would provide timely information to guide intervention policy. METHODS: We collected individual information from official public sources on laboratory-confirmed cases reported outside Hubei in mainland China for the period of Jan 19 to Feb 17, 2020. We used the date of the fourth revision of the case definition (Jan 27) to divide the epidemic into two time periods (Dec 24 to Jan 27, and Jan 28 to Feb 17) as the date of symptom onset. We estimated trends in the demographic characteristics of cases and key time-to-event intervals. We used a Bayesian approach to estimate the dynamics of the net reproduction number (R(t)) at the provincial level. FINDINGS: We collected data on 8579 cases from 30 provinces. The median age of cases was 44 years (33–56), with an increasing proportion of cases in younger age groups and in elderly people (ie, aged >64 years) as the epidemic progressed. The mean time from symptom onset to hospital admission decreased from 4·4 days (95% CI 0·0–14·0) for the period of Dec 24 to Jan 27, to 2·6 days (0·0–9·0) for the period of Jan 28 to Feb 17. The mean incubation period for the entire period was estimated at 5·2 days (1·8–12·4) and the mean serial interval at 5·1 days (1·3–11·6). The epidemic dynamics in provinces outside Hubei were highly variable but consistently included a mixture of case importations and local transmission. We estimated that the epidemic was self-sustained for less than 3 weeks, with mean Rt reaching peaks between 1·08 (95% CI 0·74–1·54) in Shenzhen city of Guangdong province and 1·71 (1·32–2·17) in Shandong province. In all the locations for which we had sufficient data coverage of Rt, Rt was estimated to be below the epidemic threshold (ie, <1) after Jan 30. INTERPRETATION: Our estimates of the incubation period and serial interval were similar, suggesting an early peak of infectiousness, with possible transmission before the onset of symptoms. Our results also indicate that, as the epidemic progressed, infectious individuals were isolated more quickly, thus shortening the window of transmission in the community. Overall, our findings indicate that strict containment measures, movement restrictions, and increased awareness of the population might have contributed to interrupt local transmission of SARS-CoV-2 outside Hubei province. FUNDING: National Science Fund for Distinguished Young Scholars, National Institute of General Medical Sciences, and European Commission Horizon 2020.


The Growing Challenge of Avian Influenza


title: Allergen immunotherapy in the current COVID-19 pandemic: A position paper of AeDA, ARIA, EAACI, DGAKI and GPA: Position paper of the German ARIA Group(A) in cooperation with the Austrian ARIA Group(B), the Swiss ARIA Group(C), German Society for Applied Allergology (AEDA)(D), German Society for Allergology and Clinical Immunology (DGAKI)(E), Society for Pediatric Allergology (GPA)(F) in cooperation with AG Clinical Immunology, Allergology and Environmental Medicine of the DGHNO-KHC(G) and the European Academy of Allergy and Clinical Immunology (EAACI)(H)

text: No abstract available.


title: Reusable elastomeric air-purifying respirators: Physiologic impact on health care workers

text: BACKGROUND: Elastomeric air-purifying respirators offer the benefit of reusability, but their physiological impact on health care workers is unknown. METHODS: Ten health care workers exercised at 2 health care-associated work rates wearing an elastomeric air-purifying respirator. Mixed inhalation/exhalation respirator dead space gases (oxygen, carbon dioxide) were sampled, and physiological parameters were monitored (heart rate, breathing rate, tidal volume, minute volume, oxygen saturation, transcutaneous carbon dioxide). Numerical rating scales were used to evaluate comfort and exertion. RESULTS: Compared with controls (no respirator), significant decreases in the breathing rate at both work rates (P < .05) and increases in tidal volume at the lower work rate (P < .01) were noted with respirator use. Approximately half the subjects had transcutaneous carbon dioxide levels above the upper limit of normal after 1 hour of use. Although well tolerated, comfort was negatively impacted by elastomeric air-purifying respirators wear. CONCLUSION: Reusable elastomeric air-purifying respirators impose little additional physiological burden over the course of 1 hour at usual health care work rates. However, the potential for carbon dioxide retention in a significant proportion of users exists and requires further investigation.


title: StralSV: assessment of sequence variability within similar 3D structures and application to polio RNA-dependent RNA polymerase

text: BACKGROUND: Most of the currently used methods for protein function prediction rely on sequence-based comparisons between a query protein and those for which a functional annotation is provided. A serious limitation of sequence similarity-based approaches for identifying residue conservation among proteins is the low confidence in assigning residue-residue correspondences among proteins when the level of sequence identity between the compared proteins is poor. Multiple sequence alignment methods are more satisfactory--still, they cannot provide reliable results at low levels of sequence identity. Our goal in the current work was to develop an algorithm that could help overcome these difficulties by facilitating the identification of structurally (and possibly functionally) relevant residue-residue correspondences between compared protein structures. RESULTS: Here we present StralSV (structure-alignment sequence variability), a new algorithm for detecting closely related structure fragments and quantifying residue frequency from tight local structure alignments. We apply StralSV in a study of the RNA-dependent RNA polymerase of poliovirus, and we demonstrate that the algorithm can be used to determine regions of the protein that are relatively unique, or that share structural similarity with proteins that would be considered distantly related. By quantifying residue frequencies among many residue-residue pairs extracted from local structural alignments, one can infer potential structural or functional importance of specific residues that are determined to be highly conserved or that deviate from a consensus. We further demonstrate that considerable detailed structural and phylogenetic information can be derived from StralSV analyses. CONCLUSIONS: StralSV is a new structure-based algorithm for identifying and aligning structure fragments that have similarity to a reference protein. StralSV analysis can be used to quantify residue-residue correspondences and identify residues that may be of particular structural or functional importance, as well as unusual or unexpected residues at a given sequence position. StralSV is provided as a web service at http://proteinmodel.org/AS2TS/STRALSV/.


title: Canadian children's and youth's adherence to the 24-h movement guidelines during the COVID-19 pandemic: A decision tree analysis

text: PURPOSE: The purpose of this study was to use decision tree modeling to generate profiles of children and youth who were more or less likely to meet the Canadian 24-h movement guidelines during the COVID-19 outbreak. METHODS: Data for this study were from a nationally representative sample of 1472 Canadian parents (Mean(age) = 45.12, SD = 7.55) of children (5–11 years old) or youth (12–17 years old). Data were collected in April 2020 via an online survey. Survey items assessed demographic, behavioral, social, micro-environmental, and macro-environmental characteristics. Four decision trees of adherence and non-adherence to all movement recommendations combined and each individual movement recommendation (physical activity, screen time, and sleep) were generated. RESULTS: Results revealed specific combinations of adherence and non-adherence characteristics. Characteristics associated with adherence to the recommendation(s) included high parental perceived capability to restrict screen time, being a boy, increases in children's and youth's outdoor physical activity/sport since the COVID-19 outbreak began, having parents younger than 43 years old (for adherence to screen time recommendation), having no to little change in sleep duration since the COVID-19 outbreak began, and having parents older than 35 years old (for adherence to the sleep recommendation). Characteristics associated with non-adherence to the recommendation(s) included low parental perceived capability to restrict screen time, decreases in children's and youth's outdoor physical activity/sport since the COVID-19 outbreak began, primary residences located in all provinces except Quebec, low parental perceived capability to support children's sleep, and increases in sleep duration since the COVID-19 outbreak began. CONCLUSION: Our results show that specific characteristics interact to contribute to (non)adherence to the movement behavior recommendations. Results highlight the importance of targeting parents’ perceived capability for the promotion of children's and youth's movement behaviors during challenging times of the COVID-19 pandemic, paying particular attention to enhancing parental perceived capability to restrict screen time.


title: Need of surveillance response systems to combat Ebola outbreaks and other emerging infectious diseases in African countries

text: There is growing concern in Sub-Saharan Africa about the spread of the Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, and the public health burden that it ensues. Since 1976, there have been 885,343 suspected and laboratory confirmed cases of EVD and the disease has claimed 2,512 cases and 932 fatality in West Africa. There are certain requirements that must be met when responding to EVD outbreaks and this process could incur certain challenges. For the purposes of this paper, five have been identified: (i) the deficiency in the development and implementation of surveillance response systems against Ebola and others infectious disease outbreaks in Africa; (ii) the lack of education and knowledge resulting in an EVD outbreak triggering panic, anxiety, psychosocial trauma, isolation and dignity impounding, stigmatisation, community ostracism and resistance to associated socio-ecological and public health consequences; (iii) limited financial resources, human technical capacity and weak community and national health system operational plans for prevention and control responses, practices and management; (iv) inadequate leadership and coordination; and (v) the lack of development of new strategies, tools and approaches, such as improved diagnostics and novel therapies including vaccines which can assist in preventing, controlling and containing Ebola outbreaks as well as the spread of the disease. Hence, there is an urgent need to develop and implement an active early warning alert and surveillance response system for outbreak response and control of emerging infectious diseases. Understanding the unending risks of transmission dynamics and resurgence is essential in implementing rapid effective response interventions tailored to specific local settings and contexts. Therefore, the following actions are recommended: (i) national and regional inter-sectorial and trans-disciplinary surveillance response systems that include early warnings, as well as critical human resources development, must be quickly adopted by allied ministries and organisations in African countries in epidemic and pandemic responses; (ii) harnessing all stakeholders commitment and advocacy in sustained funding, collaboration, communication and networking including community participation to enhance a coordinated responses, as well as tracking and prompt case management to combat challenges; (iii) more research and development in new drug discovery and vaccines; and (iv) understanding the involvement of global health to promote the establishment of public health surveillance response systems with functions of early warning, as well as monitoring and evaluation in upholding research-action programmes and innovative interventions.


title: Antimicrobial resistance in southern China: results of prospective surveillance in Dongguan city, 2017()

text: BACKGROUND: Few studies have estimated the burden of infections due to antimicrobial-resistant (AMR) pathogens in China. AIM: To summarize antimicrobial resistance and assess the frequency of community-associated infections (CAIs) and healthcare-associated infections (HCAIs) due to AMR pathogens in Dongguan city, China. METHODS: Seven acute care hospitals provided antimicrobial susceptibility data for 2017, from which ‘bug–drug’ combinations were analysed. To calculate incidence proportions of CAI and incidence densities of HCAI, data from three tertiary care hospitals were merged with patient data, obtained from the Dongguan Nosocomial Infection Surveillance System. FINDINGS: A total of 16,548 pathogens were analysed. Non-susceptibility to third-generation cephalosporins (3GCs) in Escherichia coli and Klebsiella pneumoniae was 43.9% and 30.2%, respectively. Non-susceptibility to carbapenems in Pseudomonas aeruginosa and Acinetobacter baumannii was 29.5% and 50.9%, respectively. A quarter of Staphylococcus aureus (26.3%) were non-susceptible to oxacillin. The incidence density of HCAI due to E. coli non-susceptible to 3GCs and fluoroquinolones combined was 0.09 (95% confidence interval: 0.07–0.11) per 1000 patient-days. Both E. coli and K. pneumoniae were the predominant pathogens isolated from blood. Compared with the 2017 European Antimicrobial Resistance Surveillance Network report, the incidence proportion of bloodstream infections due to multidrug-resistant E. coli was significantly higher (14.9% and 4.6%, respectively). CONCLUSION: The incidence of non-susceptible bug–drug combinations in Dongguan city was lower compared with China as a whole. Non-susceptible bug–drug combinations were significantly more frequent in HCAI compared with CAI. The incidence proportion of bloodstream infections due to multidrug-resistant pathogens in Dongguan City was higher compared with Europe.


title: SARS‐CoV‐2: March toward adaptation

text: After an initial period of rising numbers of infected subjected by SARS-CoV-2 and deaths by COVID-19, currently some areas of the World are experiencing a reduction of cases. Different degrees of lockdown and social distancing measures greatly helped in limiting the spread of the disease. The contribution of other external factors like weather conditions and population density, though not as significant, seemed nonetheless to have played an additional role in shaping the course of the epidemic. A third factor still subject of debate is how and how much the mutations observed in SARS-CoV-2 provide an indication of viral fitness and adaptation, and their role first into the initial phases of transmission and now during the reduction of viral spreading. Aim of this commentary is to provide an overview of the status of the pandemic situation linking together the different factors implicated in current situation, and to summarize some strategies that could help us to better manage either a second wave of this virus or a potential new threat of similar nature. This article is protected by copyright. All rights reserved.


title: Identifying weaknesses in national health emergency response skills and techniques with emergency responders: A cross-sectional study from China

text: BACKGROUND: To identify the weakest skill areas perceived by participants among key skills highly demanded during emergencies and to explore factors influencing the self-rated overall skill proficiency of public health emergency responders. METHODS: The participants were selected by a multistage, stratified cluster sampling method in Heilongjiang CDC to complete questionnaires that assessed their perceptions of health emergency response skills and techniques. A final sample of 1,740 staff members was obtained and analyzed. RESULTS: The 5 top skill deficiency areas perceived by participants were field epidemiologic investigation, personal protection, effective nuclear and radioactive response as well as psychological interventio (for these two areas gain the equal score), and risk assessment. The logistic regression revealed personal protective skills as the most important factor contributing to the self-rated overall skill proficiency of public health emergency responders, followed by field epidemiologic investigation skills. CONCLUSIONS: More attention should be given to emergency response skill training and education programs. Major obstacles hindering the promotion of key skills and techniques among front-line emergency responders should be addressed urgently. Continuous efforts should be made to remove the financial, technical, and resource obstacles to improve public health emergency response capacity.


title: Simultaneous detection of parainfluenza viruses 1 and 3 by real-time reverse transcription-polymerase chain reaction

text: Abstract Human parainfluenza virus (HPIV) types 1 and 3 are major viral pathogens responsible for upper and lower respiratory tract infections. The diagnosis of these two species is achieved generally by specific reverse transcription-polymerase chain (RT-PCR) reaction methods. In this study, a real-time RT-PCR was developed using a common pair of primers–probe (HPIV-1+3) for the simultaneous detection of both HPIV-1 and HPIV-3 genomes. Results obtained in a 10-fold dilution series assay demonstrate a high sensitivity of the assay with a lowest detection limit of approximately one plasmid copy for both HPIV-1 and HPIV-3. A comparison of HPIV-1 and HPIV-3 clinical sample detection between specific HPIV-1/HPIV-3 pairs of primers–probes and the HPIV-1+3 combination clearly shows that the latter is significantly more sensitive (gain of about five threshold cycles) than the former for HPIV-3 detection, while equivalent values are observed for HPIV-1. The HPIV-1+3 combination constitutes a more rapid, more sensitive, and less expensive alternative than classical or multiplex real-time RT-PCR assays usually used in clinical laboratories.


Donor Heart Selection During The COVID-19 Pandemic: A Case Study


title: Strategies for Success. Viral Infections and Membraneless Organelles

text: Regulation of RNA homeostasis or “RNAstasis” is a central step in eukaryotic gene expression. From transcription to decay, cellular messenger RNAs (mRNAs) associate with specific proteins in order to regulate their entire cycle, including mRNA localization, translation and degradation, among others. The best characterized of such RNA-protein complexes, today named membraneless organelles, are Stress Granules (SGs) and Processing Bodies (PBs) which are involved in RNA storage and RNA decay/storage, respectively. Given that SGs and PBs are generally associated with repression of gene expression, viruses have evolved different mechanisms to counteract their assembly or to use them in their favor to successfully replicate within the host environment. In this review we summarize the current knowledge about the viral regulation of SGs and PBs, which could be a potential novel target for the development of broad-spectrum antiviral therapies.


title: Inactivating influenza viruses on surfaces using hydrogen peroxide or triethylene glycol at low vapor concentrations

text: BACKGROUND: Surfaces in congregate settings, such as vehicles used for mass transportation, can become contaminated with infectious microorganisms and facilitate disease transmission. We disinfected surfaces contaminated with H1N1 influenza viruses using hydrogen peroxide (HP) vapor at concentrations below 100 ppm and triethylene glycol (TEG)-saturated air containing 2 ppm of TEG at 25°C. METHODS: Influenza viruses in aqueous suspensions were deposited on stainless-steel coupons, allowed to dry at ambient conditions, and then exposed for up to 15 minutes to 10 to 90 ppm of HP vapor or TEG-saturated air. Virus assays were done on the solution used to wash the viruses from these coupons and from coupons treated similarly but without exposure to HP or TEG vapor. RESULTS: After 2.5 minutes, exposure to 10-ppm HP vapor resulted in 99% inactivation. For air saturated with TEG at 25 to 29°C, the disinfection rate was about 1.3 log(10) reductions per hour, about 16 times faster than the measured natural inactivation rate under ambient conditions. CONCLUSIONS: Vapor concentrations of 10 ppm HP or 2 ppm TEG can provide effective surface disinfection. At these low concentrations, the potential for damage to even the avionics of an airplane would be expected to be minimal. At a TEG vapor concentration of 2 ppm, there are essentially no health risks to people.


title: Advanced morpholino oligomers: A novel approach to antiviral therapy

text: Abstract Phosphorodiamidate morpholino oligomers (PMOs) are synthetic antisense oligonucleotide analogs that are designed to interfere with translational processes by forming base-pair duplexes with specific RNA sequences. Positively charged PMOs (PMOplus™) are effective for the postexposure protection of two fulminant viral diseases, Ebola and Marburg hemorrhagic fever in nonhuman primates, and this class of antisense agent may also have possibilities for treatment of other viral diseases. PMOs are highly stable, are effective by a variety of routes of administration, can be readily formulated in common isotonic delivery vehicles, and can be rapidly designed and synthesized. These are properties which may make PMOs good candidates for use during responses to emerging or reemerging viruses that may be insensitive to available therapies or for use during outbreaks, especially in regions that lack a modern medical infrastructure. While the efficacy of sequence-specific therapies can be limited by target-site sequence variations that occur between variants or by the emergence of resistant mutants during infections, various PMO design strategies can minimize these impacts. These strategies include the use of promiscuous bases such as inosine to compensate for predicted base-pair mismatches, the use of sequences that target conserved sites between viral strains, and the use of sequences that target host products that viruses utilize for infection.


title: Transmission of Eimeria, Viruses, and Bacteria to Chicks: Darkling Beetles (Alphitobius diaperinus) as Vectors of Pathogens

text: Abstract Darkling beetle homogenates (DBH) were prepared from beetles collected from seven premises (farms). DBH were shown to contain myriad infectious organisms including bacteria (e.g., Salmonella), viruses (e.g., reovirus), and Eimeria (the causative agents of intestinal coccidiosis). The present study establishes the fact that darkling beetles serve as vectors for common avian pathogens. Darkling beetles must be considered on a list of other vectors known to transmit common poultry pathogens. The risk posed by beetles with respect to dissemination of diseases is of immense importance to the poultry industry. The possibility of severe adverse economic impact as a result of these diseases should not be overlooked or casually dismissed.


title: “Teaching old drugs to kill new bugs”: structure-based discovery of anti-SARS drugs

text: Abstract Severe acute respiratory syndrome (SARS) main protease or 3C-like protease (3CLpro) is essential for the propagation of the coronaviral life cycle and is regarded as one of the main targets for structure-based anti-SARS drug design. It is an attractive approach to find new uses for old drugs as they have already been through extensive clinical testing and could easily be accelerated for clinical approval. Briefly, we performed virtual screening of a database of small molecules against SARS 3CLpro, analyzed inhibitor–protease complexes, and identified several covalent and non-covalent inhibitors. Several old drugs that bind to SARS 3CLpro active site were selected and in silico derivatized to generate covalent irreversible inhibitors with enhanced affinity. Furthermore, we show that pharmacophores derived from clusters of compounds resulting out of virtual screening could be useful probes for future structure–activity relationship studies (SARs) and fine-tune the lead molecules identified.


title: Modelling estimates of the burden of respiratory syncytial virus infection in children in the UK

text: OBJECTIVE: The burden of respiratory syncytial virus (RSV) illness is not well characterised in primary care. We estimated the burden of disease attributable to RSV in children in the UK between 1995 and 2009. DESIGN: Time-series regression modelling. SETTING: A multiple linear regression model based on weekly viral surveillance (RSV and influenza, Public Health England), and controlled for non-specific seasonal drivers of disease, estimated the proportion of general practitioner (GP) episodes of care (counted as first visit in a series within 28 days; Clinical Practice Research Datalink, CPRD), hospitalisations (Hospital Episode Statistics, HES) and deaths (Office of National Statistics, ONS) attributable to RSV each season. PARTICIPANTS: Children 0–17 years registered with a GP in CPRD, or with a respiratory disease outcome in the HES or ONS databases. PRIMARY OUTCOME MEASURES: RSV-attributable burden of GP episodes, hospitalisations and deaths due to respiratory disease by age. RSV-attributable burden associated with selected antibiotic prescriptions. RESULTS: RSV-attributable respiratory disease in the UK resulted in an estimated 450 158 GP episodes, 29 160 hospitalisations and 83 deaths per average season in children and adolescents, with the highest proportions in children <6 months of age (14 441/100 000 population, 4184/100 000 and 6/100 000, respectively). In an average season, there were an estimated 125 478 GP episodes for otitis media and 416 133 prescriptions for antibiotics attributable to RSV. More GP episodes, hospitalisations and deaths from respiratory disease were attributable to RSV than to influenza in children under 5 years. CONCLUSIONS: The burden of RSV in children in the UK exceeds that of influenza. RSV in children and adolescents contributes substantially to GP office visits for a diverse range of illnesses, and was associated with an average 416 133 prescribed antibiotic courses per season. Effective antiviral treatments and preventive vaccines are urgently needed for the management of RSV infection in children. TRIAL REGISTRATION NUMBER: NCT01706302.


title: Drug repurposing for new, efficient, broad spectrum antivirals

text: Abstract Emerging viruses are a major threat to human health. Recent outbreaks have emphasized the urgent need for new antiviral treatments. For several pathogenic viruses, considerable efforts have focused on vaccine development. However, during epidemics infected individuals need to be treated urgently. High-throughput screening of clinically tested compounds provides a rapid means to identify undiscovered, antiviral functions for well-characterized therapeutics. Repurposed drugs can bypass part of the early cost and time needed for validation and authorization. In this review we describe recent efforts to find broad spectrum antivirals through drug repurposing. We have chosen several candidates and propose strategies to understand their mechanism of action and to determine how resistance to antivirals develops in infected cells.


title: Analytical performance of the Alere™ i Influenza A&B assay for the rapid detection of influenza viruses

text: Abstract The analytical performance of the new Alere™ i Influenza A&B kit (AL-Flu) assay, based on isothermal nucleic acids amplification, was evaluated and compared with an antigen detection method, SD Bioline Influenza Virus Antigen Test (SDB), and an automated real-time RT-PCR, Simplexa™ Flu A/B & VRS Direct assay (SPX), for detection of influenza viruses. An “in-house” RT-PCR was used as the reference method. Sensitivity of AL-Flu, SDB, and SPX was 71.7%, 34.8%, and 100%, respectively. Specificity was 100% for all techniques. The turnaround time was 13min for AL-Flu, 15min for SDB, and 75min for SPX. The Alere™ i Influenza A&B assay is an optimal point-of-care assay for influenza diagnosis in clinical emergency settings, and is more sensitive and specific than antigen detection methods.


title: Chapter 2 Genetic Instability of RNA Viruses

text: Abstract Despite having very limited coding capacity, RNA viruses are able to withstand challenge of antiviral drugs, cause epidemics in previously exposed human populations, and, in some cases, infect multiple host species. They are able to achieve this by virtue of their ability to multiply very rapidly, coupled with their extraordinary degree of genetic heterogeneity. RNA viruses exist not as single genotypes, but as a swarm of related variants, and this genomic diversity is an essential feature of their biology. RNA viruses have a variety of mechanisms that act in combination to determine their genetic heterogeneity. These include polymerase fidelity, error-mitigation mechanisms, genomic recombination, and different modes of genome replication. RNA viruses can vary in their ability to tolerate mutations, or “genetic robustness,” and several factors contribute to this. Finally, there is evidence that some RNA viruses exist close to a threshold where polymerase error rate has evolved to maximize the possible sequence space available, while avoiding the accumulation of a lethal load of deleterious mutations. We speculate that different viruses have evolved different error rates to complement the different “life-styles” they possess.


Middle East Respiratory Syndrome Coronavirus Recombination and the Evolution of Science and Public Health in China


title: COVID-19 compassion in self-isolating old age: looking forward from family to regional and global concerns

text: Self-isolating with my wife, I feel gratitude and compassion for all those supporting us, particularly those who regularly deliver our food and our immediate family members who check on us frequently. My compassion goes out to those on the “frontline”, particularly my niece and her daughter who are both nurses in a major hospital and who developed and recovered from COVID-19 symptoms. More broadly, I recognise that there are many communities that have had to cope with both geophysical and socio-politically created disasters while facing the COVID-19 pandemic, among then some young women bee-keepers in Uganda. In the UK context, I have great concern that severe funding cuts for regional and local public health services and disaster planning handicapped the country’s response to coronavirus and may have been a factor in the UK’s high coronavirus death rate. I see both positive and negative changes in air pollution and urban nature in our towns and cities, but also am concerned that we collectively may lose sight of the greater crises of climate change and species extinction. We have to work for a better future by taking forward the opportunities and lessons from our reactions to the pandemic. This leads to compassion for the yet unborn, our grandchildren’s children, who might enter a less habitable, more unequal less collaborative world than the imperfect one we now enjoy.


title: COVID-19 outbreak: current scenario of Pakistan

text: COVID-19 outbreak was first time experienced in the Wuhan City of China at the end of December 2019. Which spread rapidly in China and then worldwide in 209 countries of America, Europe, Australia and Asia including Pakistan. There are more than fifty thousand mortalities and one million plus people have been affected worldwide, while figure increases rapidly. Different steps have been taken worldwide for the control of COVID-19. Even with less resources Pakistan also taken rigorous measures like designed special hospitals, Laboratories for testing, quarantine facilities, awareness campaign and lock down to control the spread of virus. We highlighted the efforts of government to combat this deadly pneumonia.


title: Genome characterization of feline morbillivirus from Italy

text: Abstract Feline morbillivirus (FeMV) has been recently identified by RT-PCR in the urine sample of a nephropathic cat in Italy. In this report, we describe the whole genome sequence of strain Piuma/2015 obtained by combination of sequence independent single primer amplification method (SISPA) and next generation sequencing (NGS) starting from RNA purified from the infected urine sample. The existence in Germany and Turkey of FeMVs from cats divergent from Piuma/2015, suggests the presence of FeMV heterogeneity in Europe as it has been described previously in Japan and China.


title: Community-Acquired Pneumonia Visualized on CT Scans but Not Chest Radiographs Pathogens, Severity, and Clinical Outcomes

text: Background The clinical significance of pneumonia visualized on CT scan in the setting of a normal chest radiograph is uncertain. Methods In a multicenter prospective surveillance study of adults hospitalized with community-acquired pneumonia (CAP), we compared the presenting clinical features, pathogens present, and outcomes of patients with pneumonia visualized on a CT scan but not on a concurrent chest radiograph (CT-only pneumonia) and those with pneumonia visualized on a chest radiograph. All patients underwent chest radiography; the decision to obtain CT imaging was determined by the treating clinicians. Chest radiographs and CT images were interpreted by study-dedicated thoracic radiologists blinded to the clinical data. Results The study population included 2,251 adults with CAP; 2,185 patients (97%) had pneumonia visualized on chest radiography, whereas 66 patients (3%) had pneumonia visualized on CT scan but not on concurrent chest radiography. Overall, these patients with CT-only pneumonia had a clinical profile similar to those with pneumonia visualized on chest radiography, including comorbidities, vital signs, hospital length of stay, prevalence of viral (30% vs 26%) and bacterial (12% vs 14%) pathogens, ICU admission (23% vs 21%), use of mechanical ventilation (6% vs 5%), septic shock (5% vs 4%), and inhospital mortality (0 vs 2%). Conclusions Adults hospitalized with CAP who had radiological evidence of pneumonia on CT scan but not on concurrent chest radiograph had pathogens, disease severity, and outcomes similar to patients who had signs of pneumonia on chest radiography. These findings support using the same management principles for patients with CT-only pneumonia and those with pneumonia seen on chest radiography.


title: Comprehensive US government program for dried plasma development

text: Transfusion of plasma early after severe injury has been associated with improved survival. There are significant logistic factors that limit the ability to deliver plasma where needed in austere environments, such as the battlefield or during a significant civilian emergency. While some countries have access to more logistically supportable dried plasma, there is no such product approved for use in the United States. There is a clear need for a Food and Drug Administration (FDA)‐approved dried plasma for military and emergency‐preparedness uses, as well as for civilian use in remote or austere settings. The Department of Defense (DoD) and Biomedical Advanced Research and Development Authority are sponsoring development of three dried plasma products, incorporating different technologic approaches and business models. At the same time, the DoD is sponsoring prospective, randomized clinical studies on the prehospital use of plasma. These efforts are part of a coordinated program to provide a dried plasma for military and civilian applications and to produce additional information on plasma use so that, by the time we have an FDA‐approved dried plasma, we will better understand how to use it.


title: Effect of pelleting on survival of porcine epidemic diarrhea virus–contaminated feed

text: Porcine epidemic diarrhea virus (PEDV) is a heat-sensitive virus that has devastated the U.S. swine industry. Because of its heat sensitivity, we hypothesized that a steam conditioner and pellet mill mimicking traditional commercial thermal processing may mitigate PEDV infectivity. Pelleting, a common feed processing method, includes the use of steam and shear forces, resulting in increased temperature of the processed feed. Two thermal processing experiments were designed to determine if different pellet mill conditioner retention times and temperatures would impact PEDV quantity and infectivity by analysis of quantitative reverse transcription PCR and bioassay. In Exp. 1, a 3 · 3 · 2 factorial design was used with 3 pelleting temperatures (68.3, 79.4, and 90.6°C), 3 conditioning times (45, 90, or 180 s), and 2 doses of viral inoculation (low, 1 · 10(2) tissue culture infectious dose(50) (the concentration used to see cytopathic effect in 50% of the cells)/g, or high, 1 · 10(4) tissue culture infectious dose(50)/g). Noninoculated and PEDV-inoculated unprocessed mash were used as controls. The low-dose PEDV–infected mash had 6.8 ± 1.8 cycle threshold (Ct) greater (P < 0.05) PEDV than the high-dose mash. Regardless of time or temperature, pelleting reduced (P < 0.05) the quantity of detectable viral PEDV RNA compared with the PEDV-inoculated unprocessed mash. Fecal swabs from pigs inoculated with the PEDV-positive unprocessed mash, regardless of dose, were clinically PEDV positive from 2 to 7 d (end of the trial) after inoculation. However, if either PEDV dose of inoculated feed was pelleted at any of the 9 tested conditioning time · temperature combinations, no PEDV RNA was detected in fecal swabs or cecum content. Based on Exp. 1 results, a second experiment was developed to determine the impact of lower processing temperatures on PEDV quantity and infectivity. In Exp. 2, PEDV-inoculated feed was pelleted at 1 of 5 conditioning temperatures (37.8, 46.1, 54.4, 62.8, and 71.1°C) for 30 s. The 5 increasing processing temperatures led to feed with respective mean Ct values of 32.5, 34.6, 37.0, 36.5, and 36.7, respectively. All samples had detectable PEDV RNA. However, infectivity was detected by bioassay only in pigs from the 37.8 and 46.1°C conditioning temperatures. Experiment 2 results suggest conditioning and pelleting temperatures above 54.4°C could be effective in reducing the quantity and infectivity of PEDV in swine feed. However, additional research is needed to prevent subsequent recontamination after pelleting as it is a point-in-time mitigation step.


title: Selected nonvaccine interventions to prevent infectious acute respiratory disease

text: Introduction Infectious acute respiratory disease (ARD) is a significant cause of worldwide morbidity, disproportionately affecting individuals living in crowded conditions, such as found at military training centers, school dormitories, and correctional facilities. Vaccines have been used to protect against ARD; however, these are not always available or effective. Methods The medical literature (1963–2004) on preventive nonvaccine ARD interventions (NOVARDIs) for infectious diseases, which addressed personal measures, administrative controls, and engineering controls, was studied during 2000 to 2004. Population-based studies in community settings (non-health care) were reviewed in detail to evaluate the effectiveness of NOVARDIs. Budgetary and logistic factors as well as acceptance were considered in formulating recommendations for implementation of NOVARDIs in military training centers. Results Thirty-eight population-based studies contained in 35 publications were examined. Three studies contained information on multiple NOVARDIs. Nine studies supported the use of personal measures relating to hand hygiene. Ten studies supported administrative controls such as cohorting military training units to reduce contact between units (4 studies), providing adequate personal space to reduce crowding (5), and cloth barriers between beds (1); and 14 studies supported the use of engineering controls such as increased indoor air dilution and ventilation (2), dust suppression (4), and air sterilization (8). Conclusions Promoting hand hygiene and reducing crowding through the provision of adequate living space and cohorting of training units may offer benefits in respiratory disease control. These interventions, along with UV lights and air dilution/ventilation, deserve further evaluation in controlled studies to assess their efficacy. NOVARDIs could benefit military and other populations living in close contact.


title: Spread and dynamics of the COVID-19 epidemic in Italy: Effects of emergency containment measures

text: The spread of coronavirus disease 2019 (COVID-19) in Italy prompted drastic measures for transmission containment. We examine the effects of these interventions, based on modeling of the unfolding epidemic. We test modeling options of the spatially explicit type, suggested by the wave of infections spreading from the initial foci to the rest of Italy. We estimate parameters of a metacommunity Susceptible–Exposed–Infected–Recovered (SEIR)-like transmission model that includes a network of 107 provinces connected by mobility at high resolution, and the critical contribution of presymptomatic and asymptomatic transmission. We estimate a generalized reproduction number ([Formula: see text] = 3.60 [3.49 to 3.84]), the spectral radius of a suitable next-generation matrix that measures the potential spread in the absence of containment interventions. The model includes the implementation of progressive restrictions after the first case confirmed in Italy (February 21, 2020) and runs until March 25, 2020. We account for uncertainty in epidemiological reporting, and time dependence of human mobility matrices and awareness-dependent exposure probabilities. We draw scenarios of different containment measures and their impact. Results suggest that the sequence of restrictions posed to mobility and human-to-human interactions have reduced transmission by 45% (42 to 49%). Averted hospitalizations are measured by running scenarios obtained by selectively relaxing the imposed restrictions and total about [Formula: see text] individuals (as of March 25, 2020). Although a number of assumptions need to be reexamined, like age structure in social mixing patterns and in the distribution of mobility, hospitalization, and fatality, we conclude that verifiable evidence exists to support the planning of emergency measures.


Knowledge sharing during public health emergencies: from global call to effective implementation


A lesson learned from the MERS epidemic in Korea: an essay on MERS


title: Site of addition of N-acetyl-galactosamine to the E1 glycoprotein of mouse hepatitis virus-A59

text: By pulse-chase labeling with [35S]methionine and long-term labeling with 3H-sugars, the E1 glycoprotein of coronavirus MHV-A59 has been shown to acquire O-linked oligosaccharides in a two-step process. About 10 min after synthesis of the E1 protein, N-acetyl-galactosamine was added. This was followed approximately 10 min later by the addition of both galactose and sialic acid to give the mature oligosaccharides. This sequence of additions was confirmed by analyzing the 3H-labeled oligosaccharides bound to each of the E1 forms using gel filtration on P4 columns. The intracellular location of the first step was determined by exploiting the temperature sensitivity of virus release. The virus normally buds first into a smooth membrane compartment lying between the rough endoplasmic reticulum and the cis side of the Golgi stack (Tooze et al., 1984). At 31 degrees C the virus is assembled but does not appear to enter the Golgi stacks. The addition of N-acetyl- galactosamine is unaffected although the addition of galactose and sialic acid is inhibited. These results strongly suggest that addition of N-acetyl-galactosamine occurs in this budding compartment, the morphology of which is similar to that of transitional elements and vesicles.


title: Airborne transmission and precautions: facts and myths

text: SUMMARY Airborne transmission occurs only when infectious particles of <5μm, known as aerosols, are propelled into the air. The prevention of such transmission is expensive, requiring N95 respirators and negative pressure isolation rooms. This lecture first discussed whether respiratory viral infections are airborne with reference to published reviews of studies before 2008, comparative trials of surgical masks and N95 respirators, and relevant new experimental studies. However, the most recent experimental study, using naturally infected influenza volunteers as the source, showed negative results from all the manikins that were exposed. Modelling studies by ventilation engineers were then summarized to explain why these results were not unexpected. Second, the systematic review commissioned by the World Health Organization on what constituted aerosol-generating procedures was summarized. From the available evidence, endotracheal intubation either by itself or combined with other procedures (e.g. cardiopulmonary resuscitation or bronchoscopy) was consistently associated with increased risk of transmission by the generation of aerosols.


The Hajj in The Time of an Ebola outbreak in West Africa


title: Disseminated histoplasmosis in a cat in Europe

text: A cat was presented with a history of vomiting, decreased appetite and weight loss. Abnormal findings were poor body condition, pale mucous membranes, dehydration and a palpable abdominal mass. Abdominal ultrasound showed lymph node enlargement, a mass of uncertain origin, thickening of the muscularis layer of the small bowel, focal thickening of the ileum with loss of layering and free peritoneal fluid. Cytology revealed a piogranulomatous infiltrate and numerous macrophages containing oval or round yeast‐like cells 2 to 5 µm diameter with a central, spherical, lightly basophilic body surrounded by a clear halo, compatible with Histoplasma capsulatum, within the cytoplasm. Post‐mortem examination revealed cavity effusions, granulomatous nodules in lungs, intestine and omentum, thickened intestinal walls and intestinal perforation. Staining with Grocott and immunohistochemistry (IHC) revealed numerous organisms within the granulomatous reaction. H. capsulatum has a worldwide distribution in temperate and subtropical climates. To the author’s knowledge, this is the first report of feline histoplasmosis in Europe.


title: Being a dentist in the pandemic

text: Data sources The authors provide no detail as to how the review was undertaken. Therefore the paper does not provide any methodological processes for data extraction. The paper describes the assimilation of available information regarding 2019-nCoV at the time of writing. The authors provide information on the COVID-19 pandemic in order to inform front-line dentists. The paper is as essay on the available information relating to: Background to the pandemic • Coronaviruses in general • Pathogenesis • COVID-19 • Clinical manifestations • Patient characteristics • Diagnosis • Protocol for managing the disease in the clinical setting • Transmission dynamics • Transmission dynamics in dentistry practice • Infection control • Mouth rinses • Rubber dam isolation • Anti-retraction handpiece • Appropriate disinfectants • Management of medical waste. Conclusions Face-to-face communication and consistent exposure to body fluids such as blood and saliva predispose dental care workers to risk of infection and there is high risk of cross-infection. The authors apply available international guidelines to provide a protocol for managing possible exposure to patients or those suspected of having a 2019-nCoV infection. Dentists play a significant role in disrupting the transmission trail of the virus by simply postponing non-emergency care for all patients.


title: Mobile phones represent a pathway for microbial transmission: A scoping review

text: Abstract Background Mobile phones have become an integral part of modern society. As possible breeding grounds for microbial organisms, these constitute a potential global public health risk for microbial transmission. Objective Scoping review of literature examining microbial's presence on mobile phones in both health care (HC) and community settings. Methods A search (PubMed&GoogleScholar) was conducted from January 2005–December 2019 to identify English language studies. Studies were included if samples from mobile phones were tested for bacteria, fungi, and/or viruses; and if the sampling was carried out in any HC setting, and/or within the general community. Any other studies exploring mobile phones that did not identify specific microorganisms were excluded. Results A total of 56 studies were included (from 24 countries). Most studies identified the presence of bacteria (54/56), while 16 studies reported the presence of fungi. One study focused solely on RNA viruses. Staphylococcus aureus, and Coagulase-Negative Staphylococci were the most numerous identified organisms present on mobile phones. These two species and Escherichia coli were present in over a third of studies both in HC and community samples. Methicillin-resistant S. aureus, Acinetobacter sp., and Bacillus sp. were present in over a third of the studies in HC settings. Conclusions While this scoping review of literature regarding microbial identification on mobile phones in HC and community settings did not directly address the issue of SARS-CoV-2 responsible for COVID-19, this work exposes the possible role of mobile phones as a ‘Trojan horse’ contributing to the transmission of microbial infections in epidemics and pandemics.


title: Highly Pathogenic Swine Getah Virus in Blue Foxes, Eastern China, 2017

text: We isolated Getah virus from infected foxes in Shandong Province, eastern China. We sequenced the complete Getah virus genome, and phylogenetic analysis revealed a close relationship with a highly pathogenic swine epidemic strain in China. Epidemiologic investigation showed that pigs might play a pivotal role in disease transmission to foxes.


title: DETECTION OF RESPIRATORY SYNCYTIAL VIRUS (RSV) AT BIRTH IN A NEWBORN WITH RESPIRATORY DISTRESS

text: Respiratory syncytial virus (RSV) is the most common respiratory pathogen in infants and young children. From the nasopharyngeal or conjunctival mucosa of infected individuals, RSV spreads to the lower respiratory tract causing acute bronchiolitis and pneumonia after an incubation period of 4 to 6 days. In addition to its well-documented tropism for the airway epithelium, it has been shown previously that RSV can also spread hematogenously and efficiently infect extrapulmonary tissues of human hosts. Furthermore, it has been shown in animal models that RSV can spread transplacentally from the respiratory tract of a pregnant mother to the lungs of the fetus. This report describes a documented case of neonatal RSV infection strongly suggestive of prenatal transmission of this infection in humans from an infected mother to her offspring.


title: Monitoring Survivability and Infectivity of Porcine Epidemic Diarrhea Virus (PEDv) in the Infected On-Farm Earthen Manure Storages (EMS)

text: In recent years, porcine epidemic diarrhea virus (PEDv) has caused major epidemics, which has been a burden to North America’s swine industry. Low infectious dose and high viability in the environment are major challenges in eradication of this virus. To further understand the viability of PEDv in the infected manure, we longitudinally monitored survivability and infectivity of PEDv in two open earthen manure storages (EMS; previously referred to as lagoon) from two different infected swine farms identified in the province of Manitoba, Canada. Our study revealed that PEDv could survive up to 9 months in the infected EMS after the initial outbreak in the farm. The viral load varied among different layers of the EMS with an average of 1.1 × 10(5) copies/ml of EMS, independent of EMS temperature and pH. In both studied EMS, the evidence of viral replication was observed through increased viral load in the later weeks of the samplings while there was no new influx of infected manure into the EMS, which was suggestive of presence of potential alternative hosts for PEDv within the EMS. Decreasing infectivity of virus over time irrespective of increased viral load suggested the possibility of PEDv evolution within the EMS and perhaps in the new host that negatively impacted virus infectivity. Viral load in the top layer of the EMS was low and mostly non-infective suggesting that environmental factors, such as UV and sunlight, could diminish the replicability and infectivity of the virus. Thus, frequent agitation of the EMS that could expose virus to UV and sunlight might be a potential strategy for reduction of PEDv load and infectivity in the infected EMS.


title: COVID‐19: A Singapore Orthopedic Resident’s Musings in the Emergency Department

text: I felt my heart skip a beat as I took off my lead gown, preparing to put in my post-operative orders. A transient wave of apprehension, and I daresay fear swept past me that very moment. It has been a good 8 years since I've graduated medical school, with nary an exposure to emergency medicine since my intern days. I wasn't sure I could remember how to read an EKG accurately, much less manage a patient in respiratory failure.


title: Inflammatory response in mixed viral-bacterial community-acquired pneumonia

text: BACKGROUND: The role of mixed pneumonia (virus + bacteria) in community-acquired pneumonia (CAP) has been described in recent years. However, it is not known whether the systemic inflammatory profile is different compared to monomicrobial CAP. We wanted to investigate this profile of mixed viral-bacterial infection and to compare it to monomicrobial bacterial or viral CAP. METHODS: We measured baseline serum procalcitonin (PCT), C reactive protein (CRP), and white blood cell (WBC) count in 171 patients with CAP with definite etiology admitted to a tertiary hospital: 59 (34.5%) bacterial, 66 (39.%) viral and 46 (27%) mixed (viral-bacterial). RESULTS: Serum PCT levels were higher in mixed and bacterial CAP compared to viral CAP. CRP levels were higher in mixed CAP compared to the other groups. CRP was independently associated with mixed CAP. CRP levels below 26 mg/dL were indicative of an etiology other than mixed in 83% of cases, but the positive predictive value was 45%. PCT levels over 2.10 ng/mL had a positive predictive value for bacterial-involved CAP versus viral CAP of 78%, but the negative predictive value was 48%. CONCLUSIONS: Mixed CAP has a different inflammatory pattern compared to bacterial or viral CAP. High CRP levels may be useful for clinicians to suspect mixed CAP.


C-Bond Systems secures strategic partnership with MACOMA Environmental Technologies to sell FN NANO photocatalytic coatings to combat pathogen and virus spread such as COVID-19 and MRSA


title: Determining a sampling regime for PCR detection of respiratory tract viral infection at coronial post-mortem examinations

text: Death due to respiratory infection is commonly encountered at autopsy. With only one opportunity to obtain samples for identification of a causative agent, it is important to ensure that sampling regimes are optimized to provide the greatest detection, without the expense and redundancy that can arise from over-sampling. This study was performed retrospectively using data from Coronial autopsies over the period 2012–2019 from which swabs from the nasopharyngeal region, trachea and lung parenchyma, in addition to samples of lung tissue, had been submitted for multiplex PCR detection of respiratory pathogens. From 97 cases with all four samples, there were 24 with at least one positive result for viral infection. Some cases had multiple positive results and a total of 27 respiratory tract viruses were identified, of which rhinovirus, influenza A virus and respiratory syncytial virus were the most common. Seventeen of the 27 viral infections (63%) were identified in all four samples. However, in nearly all cases (96%) the nasopharyngeal swab detected the infective agent when the multiplex PCR panel had detected infection in any of the four sample types. A nasopharyngeal swab is considered to be an optimal sample for detection of respiratory tract viral infection. As the samples analyzed were acquired before the appearance of the COVID-19 virus, the applicability of this finding for COVID-19 screening is not established.


Neutralizing Antibodies against SARS-CoV-2 and Other Human Coronaviruses (Trends in Immunology 41, 355–359; 2020)


title: Survival of Escherichia coli harboring nucleic acid-hydrolyzing 3D8 scFv during RNA virus infection

text: Abstract Previously, Escherichia coli harboring the codon-optimized 3D8scFv gene (E. coli 3D8scFv) was developed as a feed additive for use in preventing norovirus infection. Here, we evaluated whether the 3D8scFv gene affects the colonization of E coli when E. coli 3D8scFv passes through the mouse gastrointestinal tract. To determine the colonization ability of E. coli 3D8scFv, E. coli cells with or without the 3D8scFv gene were fed to mice. Total DNA was extracted from the animals’ stools, stomach, small intestine and colon. All samples were amplified using 3D8scFv gene-specific primer sets. E. coli 3D8scFv begins to be excreted 1 h after feeding and that all E. coli 3D8scFv cells were excreted between 12 and 24 h after the last feeding of the cells. The previously measured gastrointestinal transit time of the mice was between 8 h and 22 h. The results of this study therefore show that E. coli 3D8scFv cannot colonize the gastrointestinal tracts of mice. In addition, if the purified 3D8 scFv protein is used as a feed additive, any associated E. coli 3D8scFv bacteria will not colonize the gastrointestinal tracts of the livestock. Thus, this feed additive meets the safety assessment criteria for the commercial use of bacteria.


Academic Radiology Departmental Operational Strategy Related to the COVID-19 Pandemic


title: Diarrhea during COVID-19 infection: pathogenesis, epidemiology, prevention and management

text: Abstract Background and aims The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 / COVID-19) pandemic is a worldwide emergency. An increasing number of diarrhea cases is reported. Here we investigate the epidemiology, clinical presentation, molecular mechanisms, management, and prevention of SARS-CoV-2 associated diarrhea. Methods We searched on PubMed, EMBASE, and Web of Science up to March 2020 to identify studies documenting diarrhea and mechansism of intestinal inflammation in patients with confirmed diagnosis of SARS-CoV-2 infection. Results Clinical studies show an incidence rate of diarrhea ranging from 2% to 50% of cases. It may precede or trail respiratory symptoms. A pooled analysis revealed an overall percentage of diarrhea onset of 10.4%. SARS-CoV uses the the angiotensin-converting enzyme 2 (ACE2) and the serine protease TMPRSS2 for S protein priming. ACE2 and TMPRSS2 are not only expressed in lung, but also in the small intestinal epithelia. ACE2 is expressed furthermore in the upper esophagus, liver, and colon. SARS-CoV-2 binding affinity to ACE2 is significantly higher (10-20 times) compared with SARS-CoV. Several reports indicate viral RNA shedding in stool detectable longer time period than in nasopharyngeal swabs. Current treatment is supportive, but several options appear promising and are the subject of investigation. Conclusion Diarrhea is a frequent presenting symptom in patients infected with SARS-CoV-2. Increasing evidence indicates possible fecal oral transmission, indicating the need for a rapid and effective modification of the screening and diagnostic algorithms. The optimal methods to prevent, manage, and treat diarrhea in COVID-19 infected patients are subjects of intensive research.


title: Integrated micro-optofluidic platform for real-time detection of airborne microorganisms

text: We demonstrate an integrated micro-optofluidic platform for real-time, continuous detection and quantification of airborne microorganisms. Measurements of the fluorescence and light scattering from single particles in a microfluidic channel are used to determine the total particle number concentration and the microorganism number concentration in real-time. The system performance is examined by evaluating standard particle measurements with various sample flow rates and the ratios of fluorescent to non-fluorescent particles. To apply this method to real-time detection of airborne microorganisms, airborne Escherichia coli, Bacillus subtilis, and Staphylococcus epidermidis cells were introduced into the micro-optofluidic platform via bioaerosol generation, and a liquid-type particle collection setup was used. We demonstrate successful discrimination of SYTO82-dyed fluorescent bacterial cells from other residue particles in a continuous and real-time manner. In comparison with traditional microscopy cell counting and colony culture methods, this micro-optofluidic platform is not only more accurate in terms of the detection efficiency for airborne microorganisms but it also provides additional information on the total particle number concentration.


title: Diagnosis and Treatment of Acute or Persistent Diarrhea

text: Studies of microbial pathogens and the toxins they produce are important for determining the mechanisms by which they cause disease and spread throughout a population. Some bacteria produce secretory enterotoxins (such as cholera toxin or the heat-labile or stable enterotoxins produced by Escherichia coli) that invade cells directly. Others invade cells or produce cytotoxins (such as those produced by Shigella, enteroinvasive E coli, or Clostridium difficile) that damage cells or trigger host responses that cause small or large bowel diseases (such as enteroaggregative or enteropathogenic E coli or Salmonella). Viruses (such as noroviruses and rotaviruses) and protozoa (such as Cryptosporidium, Giardia, or Entamoeba histolytica) disrupt cell functions and cause short- or long-term disease. Much epidemiologic data about these pathogens have been collected from community- and hospital-acquired settings, as well as from patients with traveler's or persistent diarrhea. These studies have led to practical approaches for prevention, diagnosis, and treatment.


title: Drug repurposing using computational methods to identify therapeutic options for COVID-19

text: PURPOSE: Recently, the world has been dealing with a new type of coronavirus called COVID-19 that in terms of symptoms is similar to the SARS coronavirus. Unfortunately, researchers could not find a registered therapy to treat the infection related to the virus yet. Regarding the fact that drug repurposing is a good strategy for epidemic viral infection, we applied the drug repurposing strategy using virtual screening to identify therapeutic options for COVID-19. For this purpose, five proteins of COVID-19 (3-chymotrypsin-like protease (3CLpro), Papain-Like protease (PLpro), cleavage site, HR1 and RBD in Spike protein) were selected as target proteins for drug repositioning. METHODS: First, five proteins of COVID-19 were built by homology modeling. Then FDA-approved drugs (2471 drugs) were screened against cleavage site and RBD in Spike protein via virtual screening. One hundred and twenty-eight FDA-approved drugs with the most favorable free-binding energy were attached to the cleavage site and RBD in Spike protein. Of these 128 drugs, 18 drugs have either been used currently as antiviral or have been reported to possess antiviral effects. Virtual screening was then performed for the 18 selected drugs with ACE2, 3CLpro and PLpro and HR1 and TMPRSS2. RESULTS: According to the results, glecaprevir, paritaprevir, simeprevir, ledipasvir, glycyrrhizic acid, TMC-310911, and hesperidin showed highly favorably free binding energies with all tested target proteins. CONCLUSION: The above-mentioned drugs can be regarded as candidates to treat COVID-19 infections, but further study on the efficiency of these drugs is also necessary.


title: Commentary on ‘Different antibiotic treatments for group A streptococcal pharyngitis (Review)’

text: This is a commentary of Cochrane review, published in this issue of EBCH, first published as: van Driel ML, De Sutter AIM, Keber N, Habraken H, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis (Review). Cochrane Database of Systematic Reviews 2010, Issue 10. Art. No.:CD004406. DOI: 10.1002/14651858.CD004406.pub2. Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration


title: Computational analysis of the SARS-CoV-2 and other viruses based on the Kolmogorov’s complexity and Shannon’s information theories

text: This paper tackles the information of 133 RNA viruses available in public databases under the light of several mathematical and computational tools. First, the formal concepts of distance metrics, Kolmogorov complexity and Shannon information are recalled. Second, the computational tools available presently for tackling and visualizing patterns embedded in datasets, such as the hierarchical clustering and the multidimensional scaling, are discussed. The synergies of the common application of the mathematical and computational resources are then used for exploring the RNA data, cross-evaluating the normalized compression distance, entropy and Jensen–Shannon divergence, versus representations in two and three dimensions. The results of these different perspectives give extra light in what concerns the relations between the distinct RNA viruses.


title: Exploring the critical challenges and factors influencing the E-learning system usage during COVID-19 pandemic

text: The provision and usage of online and e-learning system is becoming the main challenge for many universities during COVID-19 pandemic. E-learning system such as Blackboard has several fantastic features that would be valuable for use during this COVID-19 pandemic. However, the successful usage of e-learning system relies on understanding the adoption factors as well as the main challenges that face the current e-learning systems. There is lack of agreement about the critical challenges and factors that shape the successful usage of e-learning system during COVID-19 pandemic; hence, a clear gap has been identified in the knowledge on the critical challenges and factors of e-learning usage during this pandemic. Therefore, this study aims to explore the critical challenges that face the current e-learning systems and investigate the main factors that support the usage of e-learning system during COVID-19 pandemic. This study employed the interview method using thematic analysis through NVivo software. The interview was conducted with 30 students and 31 experts in e-learning systems at six universities from Jordan and Saudi Arabia. The findings of this study offer useful suggestions for policy-makers, designers, developers and researchers, which will enable them to get better acquainted with the key aspects of the e-learning system usage successfully during COVID-19 pandemic.


title: Porcine deltacoronavirus infection alters bacterial communities in the colon and feces of neonatal piglets

text: Porcine deltacoronavirus (PDCoV) is a novel enteropathogenic coronavirus that causes watery diarrhea in piglets. Little is known regarding the alteration of the gut microbiota in PDCoV‐induced diarrhea piglets. In this study, 5‐day‐old piglets were experimentally infected with PDCoV strain CH‐01, and all piglets developed typical clinical disease, characterized by acute and severe watery diarrhea. Histologic lesions were limited to the villous epithelium of the duodenum and ileum. Gut microbiota profiles in the colon and feces of piglets inoculated with PDCoV were investigated using 16S rRNA sequencing. The results showed that PDCoV infection reduced bacterial diversity and significantly altered the composition of the microbiota from the phylum to the genus level in the colon and feces of piglets. Firmicutes (phylum), Lactobacillaceae (family), and Lactobacillus (genus) were significantly increased (p < .01), while the abundance of Bacteroidetes (phylum) was markedly reduced in the colon and feces of the PDCoV‐infected piglets (p < .01) when compared to those of the healthy piglets. Furthermore, microbial function prediction indicated that the changes in the intestinal flora also affected the nucleotide transport and metabolism, defense, translation, and transcription function of the intestinal microbiota. The current study provides new insight into the pathology and physiology of PDCoV.


title: Domain I and II from newly emerging goose tembusu virus envelope protein functions as a dominant-negative inhibitor of virus infectivity

text: Abstract Flavivirus envelope protein locates at the outermost surface of viral particle and mediates virus entry and fusion infection, and domains I and II of E protein play an important role in this process. In this study, we have expressed and purified goose tembusu virus (GTV) E protein domains I and II (DI/II) from E. coli, and tested conceptual approach that purified protein serves as anti-viral reagent. We found that DI/II inhibited GTV JS804 infection in BHK-21 cells in a dose-dependent manner, and this inhibition activity was achieved by binding to cell membrane specifically. Moreover, JS804 treated with DI/II specific anti-serum decreased its infectivity to BHK-21 cells. Taken together, this is first to show that the purified DI/II domain of tembusu virus expressed in E. coli was able to interfere with virus infection, which opens an avenue to develop novel anti-viral regents to prevent and eventually eradicate GTV infection.


title: Effect of suckler cow vaccination against glycoprotein E (gE)-negative bovine herpesvirus type 1 (BoHV-1) on passive immunity and physiological response to subsequent bovine respiratory disease vaccination of their progeny

text: Abstract The study objectives were: 1) to characterise the development of immunocompetence in beef suckler calves from birth to three months of age, and 2) to trace glycoprotein E (gE)-negative bovine herpesvirus type 1 (BoHV-1) antibodies from dam to calf and subsequent vaccination against pneumonia. Thirty multiparous beef suckler, spring-calving cows, consisting of two genotypes were involved; Limousin×Friesian (LF) and Charolais×Limousin (CL). Cows were immunised against the inactivated antigen strain of BoHV-1 (gE- (IBR marker vaccine) at day −84 and received a booster at day −56 relative to the expected calving date (d 0). Calves were immunised at 14 and 42days of age against PI-3 virus, BRSV and Mannheimia (Pasteurella) haemolytica serotype A1 using a commercial vaccine administered subcutaneously. Additionally, calves were immunised against BoHV-1 at 42days of age, using 1 dose of a live commercial vaccine administered intranasally. Blood samples were collected from all calves (n=30) via jugular venipuncture at birth, prior to colostrum feeding (0h), at 12h (h), 24h, 72h and 168h after the initial feeding of colostrum, and at d 7, 14, 28, 42, 56 and 84 post birth. The mean ratio of gE negative antibodies circulating in the blood of LF and CL dams pre-partum scored negative to gE ab (S/N≥0.70). Antibody levels of BoHV-1 (wild type (wt)) peaked at 12h post-birth in calves and declined thereafter, as the maternal antibodies decayed. There was no difference in BoHV-1 and BRSV antibody levels in calves post vaccination.


title: Novel design for door handle—a potential technology to reduce hand contamination in the COVID-19 pandemic

text: Coronavirus disease 2019; COVID-19; 3D printing; door handle


title: Interplay between viruses and host mRNA degradation

text: Messenger RNA degradation is a fundamental cellular process that plays a critical role in regulating gene expression by controlling both the quality and the abundance of mRNAs in cells. Naturally, viruses must successfully interface with the robust cellular RNA degradation machinery to achieve an optimal balance between viral and cellular gene expression and establish a productive infection in the host. In the past several years, studies have discovered many elegant strategies that viruses have evolved to circumvent the cellular RNA degradation machinery, ranging from disarming the RNA decay pathways and co-opting the factors governing cellular mRNA stability to promoting host mRNA degradation that facilitates selective viral gene expression and alters the dynamics of host-pathogen interaction. This review summarizes the current knowledge of the multifaceted interaction between viruses and cellular mRNA degradation machinery to provide an insight into the regulatory mechanisms that influence gene expression in viral infections.


title: Is multiple sclerosis a mitochondrial disease?

text: Abstract Multiple sclerosis (MS) is a relatively common and etiologically unknown disease with no cure. It is the leading cause of neurological disability in young adults, affecting over two million people worldwide. Traditionally, MS has been considered a chronic, inflammatory disorder of the central white matter in which ensuing demyelination results in physical disability. Recently, MS has become increasingly viewed as a neurodegenerative disorder in which axonal injury, neuronal loss, and atrophy of the central nervous system leads to permanent neurological and clinical disability. In this article, we discuss the latest developments on MS research, including etiology, pathology, genetic association, EAE animal models, mechanisms of neuronal injury and axonal transport, and therapeutics. In this article, we also focus on the mechanisms of mitochondrial dysfunction that are involved in MS, including mitochondrial DNA defects, and mitochondrial structural/functional changes.


Letter from the Editor-in-Chief


title: Comparison of respiratory pathogen yields from Nasopharyngeal/Oropharyngeal swabs and sputum specimens collected from hospitalized adults in rural Western Kenya

text: Molecular diagnostic methods are becoming increasingly available for assessment of acute lower respiratory illnesses (ALRI). However, nasopharyngeal/oropharyngeal (NP/OP) swabs may not accurately reflect etiologic agents from the lower respiratory tract where sputum specimens are considered as a more representative sample. The pathogen yields from NP/OP against sputum specimens have not been extensively explored, especially in tropical countries. We compared pathogen yields from NP/OP swabs and sputum specimens from patients ≥18 years hospitalized with ALRI in rural Western Kenya. Specimens were tested for 30 pathogens using TaqMan Array Cards (TAC) and results compared using McNemar’s test. The agreement for pathogen detection between NP/OP and sputum specimens ranged between 85–100%. More viruses were detected from NP/OP specimens whereas Klebsiella pneumoniae and Mycobacterium tuberculosis were more common in sputum specimens. There was no clear advantage in using sputum over NP/OP specimens to detect pathogens of ALRI in adults using TAC in the context of this tropical setting.


title: COVID-19: Time for Post-Exposure Prophylaxis?

text: From a healthcare perspective, infection due to the novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and the ensuing syndrome called COVID-19 (coronavirus disease 2019) represents the biggest challenge the world has faced in several decades. Particularly worrisome are the high contagiousness of the virus and the saturation of hospitals’ capacity due to overwhelming caseloads. Non-pharmaceutical interventions such as quarantine and inter-personal distancing are crucial to limiting the spread of the virus in the general population, but more tailored interventions may be needed at an individual level on a case-by-case basis. In this perspective, the most insidious situation is when an individual has contact with a contagious subject without adequate protection. If rapidly recognized afterwards, this occurrence may be promptly addressed through a post-exposure chemoprophylaxis (PEP) with antiviral drugs. This strategy has been implemented for other respiratory viruses (influenza above all) and was successfully used in South Korea among healthcare workers against the Middle East respiratory syndrome (MERS) coronavirus, by providing people who were exposed to high-risk contacts with lopinavir-ritonavir plus ribavirin. Initial experiences with the use of hydroxychloroquine to prevent COVID-19 also seem promising. Post-exposure chemoprophylaxis might help mitigate the spread of SARS-CoV-2 in the current phase of the COVID-19 pandemic.


title: An Updated Systematic Review of the Therapeutic Role of Hydroxychloroquine in Coronavirus Disease-19 (COVID-19)

text: BACKGROUND AND OBJECTIVE: The world is currently experiencing the Coronavirus Disease-19 (COVID-19) pandemic. There is no approved drug for the definitive treatment of the disease. Various drugs are being tried for the treatment of COVID-19, including hydroxychloroquine (HCQ). This study was performed to systematically review the therapeutic role of HCQ in COVID-19 from the available literature. METHODS: PubMed, Embase, ClinicalTrials.gov, ICTRP (WHO), Cochrane Library databases, and two pre-print servers (medRxiv.org and Research Square) were searched for clinical studies that evaluated the therapeutic role of HCQ on COVID-19 until 10 May 2020. The available studies were critically analyzed and the data were extracted. RESULTS: A total of 663 articles were screened and 12 clinical studies (seven peer-reviewed and published studies and five non-peer-reviewed studies from pre-print servers) with a total sample size of 3543 patients were included. Some of the clinical studies demonstrated good virological and clinical outcomes with HCQ alone or in combination with azithromycin in COVID-19 patients, although the studies had major methodological limitations. Some of the other studies showed negative results with HCQ therapy along with the risk of adverse reactions. CONCLUSION: The results of efficacy and safety of HCQ in COVID-19, as obtained from the clinical studies, are not satisfactory, although many of these studies had major methodological limitations. Stronger evidence from well-designed robust randomized clinical trials is required before conclusively determining the role of HCQ in the treatment of COVID-19. Clinical prudence is required in advocating HCQ as a therapeutic armamentarium in COVID-19. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40261-020-00927-1) contains supplementary material, which is available to authorized users.


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

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


title: Viral etiology of community-acquired pneumonia among adolescents and adults with mild or moderate severity and its relation to age and severity

text: BACKGROUND: Better knowledge of distribution of respiratory viruses (RVs) in adolescents and adults with community-acquired pneumonia (CAP) is needed. METHODS: To investigate the RVs etiology among adolescents and adults with CAP, according to age and pneumonia severity index (PSI), a multi-center, prospective study was conducted from November 2010 to April 2012. Fifteen RVs were tested by polymerase chain reaction (PCR). Bacteria were detected by urinary antigen, conventional culture and PCR. RESULTS: Mean (SD) age and median (IQR) PSI score of 954 patients enrolled was 45.2 (19.5) years (range 14–94) and 42 (36). RVs were found in 262 patients (27.5%): influenza virus A (IFV A, 9.9%) comprised of pandemic H1N1 (6.7%) and seasonal H3N2 (3.5%), human rhinovirus (4.3%), adenovirus (4.2%), human metapneumovirus (1.8%), parainfluenza virus 1, 3 and 2 (1.7%, 1.5% and 1.2%). Influenza virus B, enterovirus, respiratory syncytial virus, human coronavirus and parainfluenza virus 4 were rarely detected (<1%). Frequency of IFV A was highest among patients aged between 45–64 years (p < 0.001), while adenovirus among patients aged 14–17 years (p < 0.001), no differences was found in other RVs. The proportion of pandemic H1N1 increased with severity of pneumonia evaluated by PSI (P < 0.05). CONCLUSIONS: The proportion of RVs in CAP is higher than previously reported. IFV A pneumonia are usually found in patients older than 45 years, while, adenovirus pneumonia are common in adolescents and young adults. Pandemic H1N1 virus is still recognized by PSI as a high-severity pathogen. The findings contribute baseline data on viral CAP study in China.


title: A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (COVID-19)

text: Coronavirus disease 2019 (COVID-19) is a declared global pandemic. There are multiple parameters of the clinical course and management of the COVID-19 that need optimization. A hindrance to this development is the vast amount of misinformation present due to scarcely sourced manuscript preprints and social media. This literature review aims to presents accredited and the most current studies pertaining to the basic sciences of SARS-CoV-2, clinical presentation and disease course of COVID-19, public health interventions, and current epidemiological developments. The review on basic sciences aims to clarify the jargon in virology, describe the virion structure of SARS-CoV-2 and present pertinent details relevant to clinical practice. Another component discussed is the brief history on the series of experiments used to explore the origins and evolution of the phylogeny of the viral genome of SARS-CoV-2. Additionally, the clinical and epidemiological differences between COVID-19 and other infections causing outbreaks (SARS, MERS, H1N1) are elucidated. Emphasis is placed on evidence-based medicine to evaluate the frequency of presentation of various symptoms to create a stratification system of the most important epidemiological risk factors for COVID-19. These can be used to triage and expedite risk assessment. Furthermore, the limitations and statistical strength of the diagnostic tools currently in clinical practice are evaluated. Criteria on rapid screening, discharge from hospital and discontinuation of self-quarantine are clarified. Epidemiological factors influencing the rapid rate of spread of the SARS-CoV-2 virus are described. Accurate information pertinent to improving prevention strategies is also discussed. The penultimate portion of the review aims to explain the involvement of micronutrients such as vitamin C and vitamin D in COVID19 treatment and prophylaxis. Furthermore, the biochemistry of the major candidates for novel therapies is briefly reviewed and a summary of their current status in the clinical trials is presented. Lastly, the current scientific data and status of governing bodies such as the Center of Disease Control (CDC) and the WHO on the usage of controversial therapies such as angiotensin-converting enzyme (ACE) inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs) (Ibuprofen), and corticosteroids usage in COVID-19 are discussed. The composite collection of accredited studies on each of these subtopics of COVID-19 within this review will enable clarification and focus on the current status and direction in the planning of the management of this global pandemic.


title: Chapter 5 Design of cyclodextrin-based systems for intervention execution

text: Abstract Technologies for nucleic acid delivery have displayed high practical potential in mediating genetic manipulation to modulate metabolic pathways to combat aging. In the previous chapter, we have delineated a series of techniques for designing and developing polymeric vectors as nonviral carriers. Based on what we have discussed, this chapter will introduce how the delivery performance and versatility of polymeric vectors can be further enhanced by using cyclodextrins (CDs). Over the years, CDs have shown promising application potential in different areas, ranging from controlled drug release to chiral separation of basic drugs. These applications are largely mediated by the ability of CDs to undergo host–guest inclusion complexation. Upon incorporation of CDs into the design of a polymeric vector, not only can the flexibility of the design be increased, but the development of a multifunctional carrier for genetic manipulation can also be facilitated.


Still using MS Excel? Implementation of the WHO Go.Data software for the COVID‐19 contact tracing


title: The app credibility gap

text: A slew of national COVID-19 exposure apps have failed because of poor public engagement and acceptance. Apps from the workplace may offer a partial solution if privacy can be guaranteed.


title: The Impact of COVID-19 on Interventional Radiology Training Programs: What you need to know

text: The COVID-19 pandemic has affected medical education in unprecedented ways. Herein, we briefly describe the affects of COVID-19 on Interventional Radiology residency training and summarize up to date guidance by governing bodies and key stakeholders.


title: Swine interferon-induced transmembrane protein, sIFITM3, inhibits foot-and-mouth disease virus infection in vitro and in vivo

text: Abstract The interferon-induced transmembrane protein 3 (IFITM3) is a widely expressed potent antiviral effector of the host innate immune system. It restricts a diverse group of pathogenic, enveloped viruses, by interfering with endosomal fusion. In this report, the swine IFITM3 (sIFITM3) gene was cloned. It shares the functionally conserved CD225 domain and multiple critical amino acid residues (Y19, F74, F77, R86 and Y98) with its human ortholog, which are essential for antiviral activity. Ectopic expression of sIFITM3 significantly inhibited non-enveloped foot-and-mouth disease virus (FMDV) infection in BHK-21 cells. Furthermore, sIFITM3 blocked FMDV infection at early steps in the virus life cycle by disrupting viral attachment to the host cell surface. Importantly, inoculation of 2-day-old suckling mice with a plasmid expressing sIFITM3 conferred protection against lethal challenge with FMDV. These results suggest that sIFITM3 is a promising antiviral agent and that can safeguard the host from infection with FMDV.


title: Characterizing the dynamics underlying global spread of epidemics

text: Over the past few decades, global metapopulation epidemic simulations built with worldwide air-transportation data have been the main tool for studying how epidemics spread from the origin to other parts of the world (e.g., for pandemic influenza, SARS, and Ebola). However, it remains unclear how disease epidemiology and the air-transportation network structure determine epidemic arrivals for different populations around the globe. Here, we fill this knowledge gap by developing and validating an analytical framework that requires only basic analytics from stochastic processes. We apply this framework retrospectively to the 2009 influenza pandemic and 2014 Ebola epidemic to show that key epidemic parameters could be robustly estimated in real-time from public data on local and global spread at very low computational cost. Our framework not only elucidates the dynamics underlying global spread of epidemics but also advances our capability in nowcasting and forecasting epidemics.


title: Outbreaks of Pandemic (H1N1) 2009 and Seasonal Influenza A (H3N2) on Cruise Ship

text: To determine the extent and pattern of influenza transmission and effectiveness of containment measures, we investigated dual outbreaks of pandemic (H1N1) 2009 and influenza A (H3N2) that had occurred on a cruise ship in May 2009. Of 1,970 passengers and 734 crew members, 82 (3.0%) were infected with pandemic (H1N1) 2009 virus, 98 (3.6%) with influenza A (H3N2) virus, and 2 (0.1%) with both. Among 45 children who visited the ship’s childcare center, infection rate for pandemic (H1N1) 2009 was higher than that for influenza A (H3N2) viruses. Disembarked passengers reported a high level of compliance with isolation and quarantine recommendations. We found 4 subsequent cases epidemiologically linked to passengers but no evidence of sustained transmission to the community or passengers on the next cruise. Among this population of generally healthy passengers, children seemed more susceptible to pandemic (H1N1) 2009 than to influenza (H3N2) viruses. Intensive disease control measures successfully contained these outbreaks.