title: Health Information–Seeking Patterns of the General Public and Indications for Disease Surveillance: Register-Based Study Using Lyme Disease

text: BACKGROUND: People using the Internet to find information on health issues, such as specific diseases, usually start their search from a general search engine, for example, Google. Internet searches such as these may yield results and data of questionable quality and reliability. Health Library is a free-of-charge medical portal on the Internet providing medical information for the general public. Physician’s Databases, an Internet evidence-based medicine source, provides medical information for health care professionals (HCPs) to support their clinical practice. Both databases are available throughout Finland, but the latter is used only by health professionals and pharmacies. Little is known about how the general public seeks medical information from medical sources on the Internet, how this behavior differs from HCPs’ queries, and what causes possible differences in behavior. OBJECTIVE: The aim of our study was to evaluate how the general public’s and HCPs’ information-seeking trends from Internet medical databases differ seasonally and temporally. In addition, we aimed to evaluate whether the general public’s information-seeking trends could be utilized for disease surveillance and whether media coverage could affect these seeking trends. METHODS: Lyme disease, serving as a well-defined disease model with distinct seasonal variation, was chosen as a case study. Two Internet medical databases, Health Library and Physician’s Databases, were used. We compared the general public’s article openings on Lyme disease from Health Library to HCPs’ article openings on Lyme disease from Physician’s Databases seasonally across Finland from 2011 to 2015. Additionally, media publications related to Lyme disease were searched from the largest and most popular media websites in Finland. RESULTS: Both databases, Health Library and Physician’s Databases, show visually similar patterns in temporal variations of article openings on Lyme disease in Finland from 2011 to 2015. However, Health Library openings show not only an increasing trend over time but also greater fluctuations, especially during peak opening seasons. Outside these seasons, publications in the media coincide with Health Library article openings only occasionally. CONCLUSIONS: Lyme disease–related information-seeking behaviors between the general public and HCPs from Internet medical portals share similar temporal variations, which is consistent with the trend seen in epidemiological data. Therefore, the general public’s article openings could be used as a supplementary source of information for disease surveillance. The fluctuations in article openings appeared stronger among the general public, thus, suggesting that different factors such as media coverage, affect the information-seeking behaviors of the public versus professionals. However, media coverage may also have an influence on HCPs. Not every publication was associated with an increase in openings, but the higher the media coverage by some publications, the higher the general public’s access to Health Library.


title: What infection control measures will people carry out to reduce transmission of pandemic influenza? A focus group study

text: BACKGROUND: Pandemic influenza poses a future health threat against which infection control behaviours may be an important defence. However, there is little qualitative research examining perceptions of infection control measures in the context of pandemic influenza. METHODS: Eight focus groups and one interview were conducted with a purposive sample of 31 participants. Participants were invited to discuss their perceptions of infection transmission and likely adherence to infection control measures in both non-pandemic and pandemic contexts. Infection control measures discussed included handwashing, social distancing and cough hygiene (e.g. covering mouth, disposing of tissues immediately etc.). RESULTS: Thematic analysis revealed that although participants were knowledgeable about infection transmission, most expressed unfavourable attitudes toward control behaviours in non-pandemic situations. However, with the provision of adequate education about control measures and appropriate practical support (e.g. memory aids, access to facilities), most individuals report that they are likely to adhere to infection control protocols in the event of a pandemic. Of the behaviours likely to influence infection transmission, handwashing was regarded by our participants as more feasible than cough and sneeze hygiene and more acceptable than social distancing. CONCLUSION: Handwashing could prove a useful target for health promotion, but interventions to promote infection control may need to address a number of factors identified within this study as potential barriers to carrying out infection control behaviours.


title: Viral CpG deficiency provides no evidence that dogs were intermediate hosts for SARS-CoV-2

text: Due to the scope and impact of the COVID-19 pandemic there exists a strong desire to understand where the SARS-CoV-2 virus came from and how it jumped species boundaries to humans Molecular evolutionary analyses can trace viral origins by establishing relatedness and divergence times of viruses and identifying past selective pressures However, we must uphold rigorous standards of inference and interpretation on this topic because of the ramifications of being wrong Here, we dispute the conclusions of Xia (2020) that dogs are a likely intermediate host of a SARS-CoV-2 ancestor We highlight major flaws in Xia’s inference process and his analysis of CpG deficiencies, and conclude that there is no direct evidence for the role of dogs as intermediate hosts Bats and pangolins currently have the greatest support as ancestral hosts of SARS-CoV-2, with the strong caveat that sampling of wildlife species for coronaviruses has been limited


title: The DEAD-box RNA helicase DDX5 acts as a positive regulator of Japanese encephalitis virus replication by binding to viral 3′ UTR

text: Abstract Japanese encephalitis virus (JEV), one of the causes for epidemic encephalitis, belongs to the family of Flaviviridae. In this study, we demonstrated that cellular DEAD-box RNA helicase DDX5 plays an important role in JEV replication. The knockdown of DDX5 was able to decrease JEV replication, and overexpression of DDX5 mutants lacking the helicase activity also reduced JEV replication, suggesting the helicase activity is essential for JEV replication. DDX5 knockdown did not affect virus assembly and release. GST-pulldown and co-immunoprecipitation experiments demonstrated that DDX5 could interact with JEV core protein, non-structural protein 3 (NS3) and 5 (NS5-MTase and NS5-RdRp domains). Meanwhile, we also confirmed that DDX5 interacts with these viral proteins during JEV infection. Confocal microscopy analysis showed that endogenous DDX5 is recruited to the cytoplasm and colocalizes with these viral proteins and viral RNA. RNA-pulldown experiment showed that DDX5 only binds to the JEV 3′ untranslated region (UTR). Finally, we confirmed the role of DDX5 in JEV RNA replication using JEV-replicon system. In conclusion, we identified DDX5 as a positive regulator for JEV replication.


title: Pandemics and Supply Chain Management Research: Toward a Theoretical Toolbox

text: The COVID‐19 pandemic paralyzed the world and revealed the critical importance of supply chain management – perhaps more so than any other event in modern history – in navigating crises. The extensive scope of disruption, massive spillover of effects across countries and industries, and extreme shifts in demand and supply that occurred during the COVID‐19 pandemic illustrate that pandemics are qualitatively different from typical disruptions. As such, pandemics require scholars to take a fresh look at what lenses offer understanding of supply chain phenomena in order to help supply chain managers better prepare for the next pandemic and foster transiliency (i.e., the ability to simultaneously restore some processes and change – often radically – others). To help scholars and managers achieve these aims, we offer an agenda for supply chain management research on pandemics by considering how the key tenets of well‐known and emergent theories can illuminate challenges and potential solutions. Specifically, we consider how resource dependence theory, institutional theory, resource orchestration theory, structural inertia, game theory, real options theory, event systems theory, awareness‐motivation‐capability framework, prospect theory, and tournament theory offer ideas that can help scholars build knowledge about pandemics’ effects on supply chains as well as help managers formulate responses. This article is protected by copyright. All rights reserved


title: Development of three multiplex RT-PCR assays for the detection of 12 respiratory RNA viruses

text: Abstract Three multiplex hemi-nested RT-PCR assays were developed to detect simultaneously 12 RNA respiratory viruses: influenza viruses A, B and C, human respiratory syncytial virus (hRSV), human metapneumovirus (hMPV), parainfluenza virus types 1–4 (PIV-1, -2, -3 and -4), human coronavirus OC43 and 229E (HCoV) and rhinovirus (hRV). An internal amplification control was included in one of the RT-PCR assays. The RT-PCR multiplex 1 and the hemi-nested multiplex 1 detected 1 and 0.1 TCID50 of RSV A, respectively, and 0.01 and 0.001 TCID50 of influenza virus A/H3N2, respectively. Two hundred and three nasal aspirates from hospitalised children were retrospectively tested in comparison with two conventional methods: direct immunofluorescence assay and viral isolation technique. Almost all samples (89/91) that were positive by immunofluorescence assay and/or viral isolation technique were detected by the multiplex assay. This method also detected an additional 85 viruses and 33 co-infections. The overall sensitivity (98%), rapidity and enhanced efficiency of these multiplex hemi-nested RT-PCR assays suggest that they would be a significant improvement over conventional methods for the detection of a broad spectrum of respiratory viruses.


title: Fatal Septicemic Melioidosis in a Young Military Person Possibly Co-Infected With Leptospira Interrogans and Orientia Tsutsugamushi

text: Concurrent melioidosis, leptospirosis, and scrub typhus after rural activities is rarely reported. A 19-year-old previously healthy man had fever onset after 2 weeks of military training. Pneumonia became evident on the fifth day of fever under intravenous penicillin and oral minocycline therapy. Acute respiratory failure developed the next day with shock and acute renal and liver function deterioration, which resulted in death. Blood cultures on the third and fifth days grew Burkholderia pseudomallei. Serology revealed leptospirosis and scrub typhus. The emergence of melioidosis in Taiwan and this death without antibiotic treatment for melioidosis alert us that B. pseudomallei should be included as a possible pathogen of pneumonia and sepsis, especially after rural activities.


title: Respiratory Viral Infections in Solid Organ and Hematopoietic Stem Cell Transplantation

text: Respiratory viruses are common in solid organ and hematopoietic stem cell transplant recipients and a recognized cause of significant morbidity and mortality. Epidemiology, risk factors, and attributable mortality in both populations are reviewed. In addition, virus-specific prevention and treatment options, including emerging investigational therapies, are discussed for respiratory syncytial virus, influenza, adenovirus, parainfluenza, and other respiratory viruses.


title: Infections à rhinovirus chez des enfants hospitalisés: étude sur une période de 3 ans

text: Summary Background. Rhinoviruses (RH) are responsible for acute respiratory illnesses, mainly in the upper respiratory tract. Population and methods. — 3,152 children aged under 16 years, admitted to the Paediatrics department of the University Hospital Centre of Poitiers from January 1, 1993 to December 31, 1995 with ear, nose and throat (ENT) and/or respiratory symptoms were systematically investigated. One hundred and forty-five RH strains were isolated from nasopharyngeal secretions of 87 boys and 58 girls (mean age: 20.3 months). Among these, 92 (63.4%) were less than 1 year of age. Bacteriological investigations were done for 29 patients when a concomitant bacterial infection was suspected. Results. RH infection rate was maximum before 1 year of age (median age: 6.5 months) and decreased with age. RH were isolated throughout the 3 years, with a first peak from February to April, and a second one in autumn. The main symptoms were sibilants (27.6%) and cough (24.1%). Sibilants were more frequently associated in children under 12 months of age (P = 0.01). Sometimes, ophthalmologic or digestive symptoms were present. Three children with respiratory distress were transferred to the reanimation ward. In addition, a RH strain was isolated from a child who died of sudden infant death. Thirty-four children (23.4%) were co-infected by one or several viruses; the most frequently detected were the respiratory syncytial virus (41.2%) and the adenoviruses (35.3%). Twenty-nine children were infected by two viruses and five by three. Associated bacterial infections were diagnosed in 23 children, especially conjunctivitis due to Haemophilus influenzae (21.7%). Among these children, eight had a multiple viral infection. Conclusion. RH have a limited pathogenicity but can be associated with serious illnesses among infants and childen.


Human cytomegalovirus-specific CD4+ and CD8+ T-cells in organ transplant recipients


title: Pathological evidence of pulmonary thrombotic phenomena in severe COVID‐19

text: Between February and March 2020, the Journal of Thrombosis and Hemosthasis has published four papers addressing the intricate, complex and still little understood relation between COVID‐19 and thrombogenesis (1‐4). ARS‐Cov‐2 induces in severe cases a cytokine storm that ultimately leads to the activation of the coagulation cascade, causing thrombotic phenomena (5). There is a further strong link between abnormal coagulation parameters (D‐dimer and fibrin degradation products) and mortality. Tang et al. described that 71.4% of nonsurvivors and 0.6% of survivors showed evidence of disseminated intravascular coagulation (DIC), suggesting that DIC is a frequent occurrence in severe COVID‐19 (4). The frequency of DIC in these patients is much higher than that reported for severe SARS (6).


title: An in vivo cell-based assay for investigating the specific interaction between the SARS-CoV N-protein and its viral RNA packaging sequence

text: Abstract The SARS-CoV nucleocapsid (N) protein serves multiple functions in viral replication, transcription, and assembly of the viral genome complex. Coronaviruses specifically package genomic RNA into assembled virions, and in SARS-CoV, it is reported that this process is driven by an interaction between the N-protein and a packaging signal encoded within the viral RNA. While recent studies have uncovered the sequence of this packaging signal, little is known about the specific interaction between the N-protein and the packaging signal sequence, and the mechanisms by which this interaction drives viral genome packaging. In this study, we developed a novel in vivo cell-based assay for examining this interaction between the N-protein and packaging signal RNA for SARS-CoV, as well as other viruses within the coronaviridae family. Our results demonstrate that the N-protein specifically recognizes the SARS-CoV packaging signal with greater affinity compared to signals from other coronaviruses or non-coronavirus species. We also use deletion mapping to identify a 151-nt region within the packaging signal sequence that is critical for N-protein-RNA binding, and conversely, we show that both the N-terminal and C-terminal domains of the N protein are necessary for recognizing the packaging RNA. These results describe, for the first time, in vivo evidence for an interaction between the SARS-CoV N-protein and its packaging signal RNA, and demonstrate the feasibility of using this cell-based assay to further probe viral RNA-protein interactions in future studies.


title: Improving the wind environment in high-density cities by understanding urban morphology and surface roughness: A study in Hong Kong

text: Abstract In this study, a high-resolution frontal area density (FAD) map that depicts the surface roughness of urban Hong Kong is produced using a mapping method that takes into account the dense urban morphology and the site wind availability of the territory. Using the MM5/CALMET model simulated wind data of Hong Kong, the FAD map of three urban zones are calculated: podium (0–15m), building (15–60m), and urban canopy (0–60m). The wind tunnel test data is used to correlate the FAD understanding of the three zones. The grid sensitivity test indicates that 200m×200m is the reasonable resolution for the FAD map; the test also establishes that the lower urban podium zone yields the best correlation with the experimental data. The study further establishes that the simpler two-dimensional ground coverage ratio (GCR), which is readily available in the planning circle, can be used to predict the area's average pedestrian level urban ventilation performance of the city. Working with their inhouse GIS team using available data, it allows the planners a way to understand the urban ventilation of the city for decisions related to air paths, urban permeability and site porosity.


title: Estimation of Time-Dependent Reproduction Numbers for Porcine Reproductive and Respiratory Syndrome across Different Regions and Production Systems of the US

text: Porcine reproductive and respiratory syndrome (PRRS) is, arguably, the most impactful disease for the North American swine industry, due to its known considerable economic losses. The Swine Health Monitoring Project (SHMP) monitors and reports weekly new PRRS cases in 766 sow herds across the US. The time-dependent reproduction number (TD-R) is a measure of a pathogen’s transmissibility. It may serve to capture and report PRRS virus (PRRSV) spread at the regional and system levels. The primary objective of the study here was to estimate the TD-R values for PRRSV using regional and system-level PRRS data, and to contrast it with commonly used metrics of disease, such as incidence estimates and space–time clusters. The second objective was to test whether the estimated TD-Rs were homogenous across four US regions. Retrospective monthly incidence data (2009–2016) were available from the SHMP. The dataset was divided into four regions based on location of participants, and demographic and environmental features, namely, South East (North Carolina), Upper Midwest East (UME, Minnesota/Iowa), Upper Midwest West (Nebraska/South Dakota), and South (Oklahoma panhandle). Generation time distributions were fit to incidence data for each region, and used to calculate the TD-Rs. The Kruskal–Wallis test was used to determine whether the median TD-Rs differed across the four areas. Furthermore, we used a space–time permutation model to assess spatial–temporal patterns for the four regions. Results showed TD-Rs were right skewed with median values close to “1” across all regions, confirming that PRRS has an overall endemic nature. Variation in the TD-R patterns was noted across regions and production systems. Statistically significant periods of PRRSV spread (TD-R > 1) were identified for all regions except UME. A minimum of three space–time clusters were detected for all regions considering the time period examined herein; and their overlap with “spreader events” identified by the TD-R method varied according to region. TD-Rs may help to measure PRRS spread to understand, in quantitative terms, disease spread, and, ultimately, support the design, implementation, and monitoring of interventions aimed at mitigating the impact of PRRSV spread in the US.


title: Synchronized shift of oral, faecal and urinary microbiotas in bats and natural infection dynamics during seasonal reproduction

text: Seasonal reproduction is a period of extreme physiological and behavioural changes, yet we know little about how it may affect host microbial communities (i.e. microbiota) and pathogen transmission. Here, we investigated shifts of the bacterial microbiota in saliva, urine and faeces during the seasonal reproduction of bats in South Africa, and test for an interaction in shedding patterns of both bacterial (Leptospira) and viral (adeno- and herpesviruses) agents. Based on a comparative approach in two cave-dwelling bat species and high-throughput sequencing of the 16S rRNA gene, we demonstrated a clear signature in microbiota changes over the reproduction season, consistent across the multiple body habitats investigated, and associated with the sex, age and reproductive condition of bats. We observed in parallel highly dynamic shedding patterns for both bacteria and viruses, but did not find a significant association between viral shedding and bacterial microbiota composition. Indeed, only Leptospira shedding was associated with alterations in both the diversity and composition of the urinary microbiota. These results illustrate how seasonal reproduction in bats substantially affects microbiota composition and infection dynamics, and have broad implications for the understanding of disease ecology in important reservoir hosts, such as bats.


title: Pathogeography: leveraging the biogeography of human infectious diseases for global health management

text: Biogeography is an implicit and fundamental component of almost every dimension of modern biology, from natural selection and speciation to invasive species and biodiversity management. However, biogeography has rarely been integrated into human or veterinary medicine nor routinely leveraged for global health management. Here we review the theory and application of biogeography to the research and management of human infectious diseases, an integration we refer to as ‘pathogeography’. Pathogeography represents a promising framework for understanding and decomposing the spatial distributions, diversity patterns and emergence risks of human infectious diseases into interpretable components of dynamic socio‐ecological systems. Analytical tools from biogeography are already helping to improve our understanding of individual infectious disease distributions and the processes that shape them in space and time. At higher levels of organization, biogeographical studies of diseases are rarer but increasing, improving our ability to describe and explain patterns that emerge at the level of disease communities (e.g. co‐occurrence, diversity patterns, biogeographic regionalisation). Even in a highly globalized world most human infectious diseases remain constrained in their geographic distributions by ecological barriers to the dispersal or establishment of their causal pathogens, reservoir hosts and/or vectors. These same processes underpin the spatial arrangement of other taxa, such as mammalian biodiversity, providing a strong empirical ‘prior’ with which to assess the potential distributions of infectious diseases when data on their occurrence is unavailable or limited. In the absence of quality data, generalized biogeographic patterns could provide the earliest (and in some cases the only) insights into the potential distributions of many poorly known or emerging, or as‐yet‐unknown, infectious disease risks. Encouraging more community ecologists and biogeographers to collaborate with health professionals (and vice versa) has the potential to improve our understanding of infectious disease systems and identify novel management strategies to improve local, global and planetary health.


title: Lambda interferons come to light: dual function cytokines mediating antiviral immunity and damage control

text: Lambda interferons (IFNλs, type III IFNs or interleukins-28/29) were described fifteen years ago as novel cytokines sharing structural and functional homology with IL-10 and type I IFNs, respectively. IFNλs engage a unique receptor complex comprising IFNLR1 and IL10R2, nevertheless they share signaling cascade and many functions with type I IFNs, questioning their possible non-redundant roles and overall biological importance. Here, we review the latest evidence establishing the primacy of IFNλs in front line protection at anatomical barriers, mediating antiviral immunity before type I IFNs. We also discuss their emerging role in regulating inflammation and limiting host damage, a major difference to type I IFNs. IFNλs come thus to light as dual function cytokines mediating antiviral immunity and damage control.


title: Clinical Characteristics, Associated Factors, and Predicting COVID-19 Mortality Risk: A Retrospective Study in Wuhan, China

text: Introduction Coronavirus disease 2019 (COVID-19) has become a serious global pandemic. This study investigates the clinical characteristics and risk factors for COVID-19 mortality, and establishes a novel scoring system to predict mortality risk in COVID-19 patients. Methods A cohort of 1,663 hospitalized COVID-19 patients in Wuhan, China, of whom 212 died and 1,252 recovered, were included in the present study. Demographic, clinical, and laboratory data on admission were collected from electronic medical records between January 14, 2020, and February 28, 2020. Clinical outcomes were collected until March 26, 2020. Multivariable logistic regression was used to explore the association between potential risk factors and COVID-19 mortality. The receiver operating characteristic curve was used to predict COVID-19 mortality risk. All analyses were conducted in April 2020. Results Multivariable regression showed increased odds of COVID-19 mortality associated with older age (OR=2.15, 95% CI=1.35, 3.43), male sex (OR=1.97, 95% CI=1.29, 2.99), history of diabetes (OR=2.34, 95% CI=1.45, 3.76), lymphopenia (OR=1.59, 95% CI=1.03, 2.46), and increased procalcitonin (OR=3.91, 95% CI=2.22, 6.91, per SD increase) on admission. Spline regression analysis indicated that the correlation between procalcitonin levels and COVID-19 mortality was nonlinear (p=0.0004 for nonlinearity). The area under the receiver operating curve of the COVID-19 mortality risk was 0.765 (95% CI=0.725, 0.805). Conclusions The independent risk factors for COVID-19 mortality included older age, male sex, history of diabetes, lymphopenia, and increased procalcitonin, which could help clinicians to identify COVID-19 patients with poor prognosis at an earlier stage. The COVID-19 mortality risk score model may assist clinicians in reducing COVID-19-related mortality by implementing better strategies for more effective use of limited medical resources.


Cutaneous manifestations in COVID‐19: a skin rash in a child


title: Diarrhoea as the presenting sign in an adolescent suffering from severe acute respiratory syndrome

text: Patients with severe acute respiratory syndrome (SARS) may present with extra-pulmonary symptoms. We report a 16-year-old adolescent with SARS who presented with diarrhoea. Treatment directed against SARS was prompted by an epidemiological link and the clinical picture as the disease evolved. This atypical presentation posed a diagnostic challenge for physicians. Conclusion:Proper disposal of patient excreta is important to prevent the spread of severe acute respiratory syndrome.


Pandemic: Radiologists’ Ethical and Professional Responsibilities


title: Optical techniques for fast screening – towards prevention of the coronavirus COVID-19 outbreak

text: • Coronavirus disease 2019 (COVID-19) is emerging and requires early diagnostics. • Biomarkers are present for coronaviruses. • Raman and FT-IR spectroscopy are green technologies capable of high-throughput virus sensing.


Can Hypericum perforatum (SJW) prevent cytokine storm in COVID‐19 patients?


title: Beyond Deaths per Capita: Three CoViD-19 Mortality Indicators for Temporal and International Comparisons

text: CoViD-19 deaths to population size ratios fail to account for well-documented age and sex differences in CoViD-19 mortality. To assess trends across populations for which CoViD-19 deaths might not be available by age and sex, an indirect age-and-sex adjustment can still be performed. The corresponding Comparative CoViD-19 Mortality Ratio (CCMR) only requires population age and sex compositions. To compare CoViD-19 and overall mortality levels, the Crude Death Rate (CDR) and life expectancy at birth for recent calendar years are the most widely available overall mortality indicators. Readily comparable to an annual CDR, a Crude CoViD-19 Death Rate (CCDR) can be calculated for periods of any duration. CoViD-19-induced declines in projected life expectancy at birth for 2020 can also be calculated from existing life tables. We calculate the CCMR and CCDR for the period from their first CoViD-19 death to the present using US age and sex data and current estimates of CoViD-19 deaths in 166 Countries whose population composition is available from the UN, 28 Provinces in China, the 50 United States and DC. Across these 245 populations, 14 States and 11 Countries have CCMR values above 1—the US value by construction. Most affected to date, the period CCDR in New York exceeds its CDR for the most recent year available (7.83 per thousand in 2017). We also calculate CCMR and CCDR values corresponding to projections for the 50 States and DC, and for 49 countries, for which we can additionally calculate reductions in 2020 life expectancy at birth using UN life tables. This suggests life-expectancy reductions between .5 and 1 year for 7 European Countries, 3 South-American Countries and the US. The .55 reduction in the U.S. amounts to nearly twice the largest single-year decline induced by HIV/AIDS (−.3 between 1992 and 1993) or the total decline induced by opioid overdoses (also −.3 between 2014 and 2017), and would bring US life expectancy at birth down to its lowest level since 2008. As current CoViD-19 death counts likely underestimate the total increase in deaths and current projections do not account for possible new infection waves later this year, the impact on 2020 life expectancies at birth should be expected to exceed these figures.


title: Manifestaciones neuroftalmológicas como complicación de una infección por Mycoplasma pneumoniae y desarrollo posterior de una encefalitis aguda diseminada

text: Resumen El objetivo es describir dos cuadros clínicos neuroftalmológicos en niños por infección sistémica por Mycoplasma pneumoniae (M. pneumoniae). Se presentan los casos de dos niñas de 14 y 12 años que acudieron a urgencias: la primera con oftalmoplejía internuclear y la segunda con pérdida de visión y cefalea. No presentaban otra focalidad neurológica. En la imagen de resonancia magnética se evidenciaron placas hiperintensas en ambas, sugerentes de cuadro desmielinizante. Al mes, los síntomas neuroftalmológicos se resolvieron y las resonancias magnéticas de control fueron normales. El diagnóstico fue encefalitis diseminada aguda secundaria a M. pneumoniae. El diagnóstico se hace por PCR (gold standard) y/o IgM en serología. Es importante pensar en esta posible etiología ante casos sugerentes de enfermedad desmielinizante. Existe controversia sobre el papel de los antibióticos y si se contemplan los corticoides. Como conclusión, M. pneumoniae debe ser diagnóstico diferencial en afectaciones neuroftalmológicas agudas en niños. Abstract The purpose of this article is to describe two paediatric neuro-ophthalmological clinical cases caused by a systemic infection due to Mycoplasma pneumoniae (M. pneumoniae). The cases are two girls aged 14 and 12 seen in the Emergency Department: The first one had internuclear ophthalmoplegia and second with loss of vision and headache. They had no other neurological foci. Magnetic resonance imaging showed hyperintense plaques in both, suggestive of a demyelinating disease. One month later, the neuro-ophthalmological symptoms resolved, with normal follow-up magnetic resonance imagings. The diagnosis was acute disseminated encephalitis secondary to M. pneumoniae. The diagnosis was made using PCR (gold standard) and/or IgM in serology. It is important to think about this possible aetiology in cases of suggestive demyelinating disease. There is controversy about the role of antibiotics and on whether corticosteroids are contemplated. In conclusion, M. pneumoniae must be a differential diagnosis in acute neuro-ophthalmological disorders in children.


title: The term “physical distancing” is recommended rather than “social distancing” during the COVID-19 pandemic for reducing feelings of rejection among people with mental health problems

text: As COVID-19 has plagued our world, the term “social distancing” has been widely used with the aim to encourage the general population to physically distance themselves from others in order to reduce the spread of the virus. However, this term can have unintended but detrimental effects, as it evokes negative feelings of being ignored, unwelcome, left alone with one's own fears, and even excluded from society. These feelings may be stronger in people with mental illnesses and in socio-economically disadvantaged groups, such as stigmatized minorities, migrants, and homeless persons [1], many of them also having high risk for suicidal behaviors [2]. Mental health disorders are pervasive worldwide; the global burden accounting for approximately 21.2–32.4% of years lived with disability—more than any other group of illnesses [3]. So, the vulnerable group of people with mental health disorders represents a considerable share of the total global population.


title: Flight of the COVID-19 patient: experience with a Wuhan evacuee: a case report

text: BACKGROUND: Coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, was declared a global pandemic by the World Health Organization in March 2020. CASE PRESENTATION: We report a case of a 51-year-old Chinese woman who was evacuated from Wuhan, China and diagnosed with coronavirus disease 2019 infection at a Southern California quarantine facility. Her clinical course was notable for high fevers, night sweats, productive cough, transient leukopenia, lymphopenia, thrombocytopenia, and transaminitis. Evolving hypoxia and infiltrates on chest imaging warranted the trial of an investigational antiviral drug - remdesivir. Our patient recovered and was discharged after 2 weeks of hospitalization. CONCLUSIONS: This case highlights our patient’s clinical course, including diagnostic work-up, medical management, and challenges in defining non-infectivity in a relatively unknown disease.


title: Tissue Tropism and Transmission Ecology Predict Virulence of Human RNA Viruses

text: Novel infectious diseases continue to emerge within human populations. Predictive studies have begun to identify pathogen traits associated with emergence. However, emerging pathogens vary widely in virulence, a key determinant of their ultimate risk to public health. Here, we use structured literature searches to review the virulence of each of the 214 known human-infective RNA virus species. We then use a machine learning framework to determine whether viral virulence can be predicted by ecological traits including human-to-human transmissibility, transmission routes, tissue tropisms and host range. Using severity of clinical disease as a measurement of virulence, we identified potential risk factors using predictive classification tree and random forest ensemble models. The random forest model predicted literature-assigned disease severity of test data with 90.3% accuracy, compared to a null accuracy of 74.2%. In addition to viral taxonomy, the ability to cause systemic infection, having renal and/or neural tropism, direct contact or respiratory transmission, and limited (0 < R0 ≤ 1) human-to-human transmissibility were the strongest predictors of severe disease. We present a novel, comparative perspective on the virulence of all currently known human RNA virus species. The risk factors identified may provide novel perspectives in understanding the evolution of virulence and elucidating molecular virulence mechanisms. These risk factors could also improve planning and preparedness in public health strategies as part of a predictive framework for novel human infections. Author Summary Newly emerging infectious diseases present potentially serious threats to global health. Although studies have begun to identify pathogen traits associated with the emergence of new human diseases, these do not address why emerging infections vary in the severity of disease they cause, often termed ‘virulence’. We test whether ecological traits of human viruses can act as predictors of virulence, as suggested by theoretical studies. We conduct the first systematic review of virulence across all currently known human RNA virus species. We adopt a machine learning approach by constructing a random forest, a model that aims to optimally predict an outcome using a specific structure of predictors. Predictions matched literature-assigned ratings for 28 of 31 test set viruses. Our predictive model suggests that higher virulence is associated with infection of multiple organ systems, nervous systems or the renal systems. Higher virulence was also associated with contact-based or airborne transmission, and limited capability to transmit between humans. These risk factors may provide novel starting points for questioning why virulence should evolve and identifying causative mechanisms of virulence. In addition, our work could suggest priority targets for infectious disease surveillance and future public health risk strategies. Blurb Comparative analysis using machine learning shows specificity of tissue tropism and transmission biology can act as predictive risk factors for virulence of human RNA viruses.


title: Rotavirus infections in calves in dairy herds

text: Neonatal calf diarrhoea was studied in 115 calves of one dairy herd from January 1976 to June 1977. Two syndromes could he distinguished: a mild and short lasting ‘early diarrhoea’ within the first three days of life and a usually more severe ‘late diarrhoea’ from the fourth to the 14th day of life. The latter type of diarrhoea occurred almost exclusively during the first half of the year. Thirty-four out of 45 calves with late diarrhoea excreted rotaviruses, whereas only one of 34 calves with early diarrhoea excreted virus. In addition, rotavirus excretion was found in 11 calves that cither remained healthy or had recovered from diarrhoea before virus was first detected. Similar findings were obtained in the spring of 1978 but in addition bovine Coronavirus was recovered from four calves with late diarrhoea and from three healthy calves. One faecal sample obtained from a calf with diarrhoea on day 2 yielded K99+ Escherichia coli. Nearly all cows excreted rotavirus-specilic antibodies in their colostrum but no relationship was found between the initial colostral antibody titre against rotavirus and the development of rotavirus-associated diarrhoea in the calf.


Coronavirus and Risk Analysis


title: Spread of infectious microbes during emergency medical response

text: BACKGROUND: To our knowledge, no studies to date demonstrate potential spread of microbes during actual emergency medical service (EMS) activities. Our study introduces a novel approach to identification of contributors to EMS environment contamination and development of infection control strategies, using a bacteriophage surrogate for pathogenic organisms. METHODS: Bacteriophage ΦX174 was used to trace cross-contamination and evaluate current disinfection practices and a hydrogen peroxide (H(2)O(2)) wipe intervention within emergency response vehicles. Prior to EMS calls, 2 surfaces were seeded with ΦX174. On call completion, EMS vehicle and equipment surfaces were sampled before decontamination, after decontamination per current practices, and after implementation of the intervention. RESULTS: Current decontamination practices did not significantly reduce viral loads on surfaces (P = .3113), but H(2)O(2) wipe intervention did (P = .0065). Bacteriophage spread to 56% (27/48) of sites and was reduced to 54% (26/48) and 40% (19/48) with current decontamination practices and intervention practices, respectively. CONCLUSION: Results suggest firefighters' hands were the main vehicles of microbial transfer. Current practices were not consistently applied or standardized and minimally reduced prevalence and quantity of microbial contamination on EMS surfaces. Although use of a consistent protocol of H(2)O(2) wipes significantly reduced percent prevalence and concentration of viruses, training and promotion of surface disinfection should be provided.


title: SUMO and Cytoplasmic RNA Viruses: From Enemies to Best Friends

text: SUMO is a ubiquitin-like protein that covalently binds to lysine residues of target proteins and regulates many biological processes such as protein subcellular localization or stability, transcription, DNA repair, innate immunity, or antiviral defense. SUMO has a critical role in the signaling pathway governing type I interferon (IFN) production, and among the SUMOylation substrates are many IFN-induced proteins. The overall effect of IFN is increasing global SUMOylation, pointing to SUMO as part of the antiviral stress response. Viral agents have developed different mechanisms to counteract the antiviral activities exerted by SUMO, and some viruses have evolved to exploit the host SUMOylation machinery to modify their own proteins. The exploitation of SUMO has been mainly linked to nuclear replicating viruses due to the predominant nuclear localization of SUMO proteins and enzymes involved in SUMOylation. However, SUMOylation of numerous viral proteins encoded by RNA viruses replicating at the cytoplasm has been lately described. Whether nuclear localization of these viral proteins is required for their SUMOylation is unclear. Here, we summarize the studies on exploitation of SUMOylation by cytoplasmic RNA viruses and discuss about the requirement for nuclear localization of their proteins.


title: Effective inhibition of MERS-CoV infection by resveratrol

text: BACKGROUND: Middle East Respiratory Syndrome coronavirus (MERS-CoV) is an emerging viral pathogen that causes severe morbidity and mortality. Up to date, there is no approved or licensed vaccine or antiviral medicines can be used to treat MERS-CoV-infected patients. Here, we analyzed the antiviral activities of resveratrol, a natural compound found in grape seeds and skin and in red wine, against MERS-CoV infection. METHODS: We performed MTT and neutral red uptake assays to assess the survival rates of MERS-infected Vero E6 cells. In addition, quantitative PCR, western blotting, and immunofluorescent assays determined the intracellular viral RNA and protein expression. For viral productivity, we utilized plaque assays to confirm the antiviral properties of resveratrol against MERS-CoV. RESULTS: Resveratrol significantly inhibited MERS-CoV infection and prolonged cellular survival after virus infection. We also found that the expression of nucleocapsid (N) protein essential for MERS-CoV replication was decreased after resveratrol treatment. Furthermore, resveratrol down-regulated the apoptosis induced by MERS-CoV in vitro. By consecutive administration of resveratrol, we were able to reduce the concentration of resveratrol while achieving inhibitory effectiveness against MERS-CoV. CONCLUSION: In this study, we first demonstrated that resveratrol is a potent anti-MERS agent in vitro. We perceive that resveratrol can be a potential antiviral agent against MERS-CoV infection in the near future.


title: Laparoscopic surgery reduces the incidence of surgical site infections compared to the open approach for colorectal procedures: a meta-analysis

text: BACKGROUND: Surgical site infections (SSI) are the commonest healthcare associated infections. They severely compromise patient safety, are a significant burden on healthcare resources and have an adverse impact on patient quality of life. The incidence of SSIs can be as high as 10% after colorectal procedures. The laparoscopic approach is being increasingly used to undertake colorectal procedures. It provides advantages over the traditional open approach with smaller incisions, shorter hospital stay and equal oncological outcomes. The aim of this meta-analysis was to evaluate whether the laparoscopic approach for colorectal procedures reduces the incidence of SSI compared to the open approach. METHODS: Randomised controlled trials (RCTs) comparing the two approaches published since 2000 were included in the review. Revman 5.3 software was used to carry out the review. Data were pooled and the results were shown as risk ratios with 95% confidence intervals using the fixed effects model. RESULTS: Sixteen RCT’s were included in the analysis comprising 5797 patients. These covered a range of colorectal pathologies including colon cancer, rectal cancer, inflammatory bowel disease and familial adenomatous polyposis syndrome. Analysis showed significantly lower wound infection rates (RR: 0.72, 95% confidence interval: 0.60–0.88, p = 0.001) and lower abdominal abscess rates (RR: 0.88, 95% CI 0.62–1.27, p = 0.51). The combined SSI rate was significantly lower in laparoscopic compared to open surgery (RR: 0.76, 95% CI 0.64–0.90, p = 0.001). CONCLUSIONS: Laparoscopic colorectal surgery significantly lowers the incidence of SSI compared to open surgery. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10151-020-02293-8) contains supplementary material, which is available to authorized users.


title: 2019-nCoV: Measures Adopted at the Departments of Oral Surgery and Radiology during the Period of an Uncontrolled Transmission Increase

text: A new mutation of 2019-nCoV emerged and has been spreading worldwide. Dental practices are an important person-to-person transmission route. In this regard, preventive measures are required to avoid the cross contamination among professionals and patients. This report brings recommended measures for dental assistance during the pandemic phase. The clinical protocol applied at the Department of Oral Maxillofacial and Surgery, such as at the Department of Radiology, Hospital University Münster, is described. A management protocol was applied to prevent the transmission route of 2019-nCoV. Patients infected with 2019-nCoV are treated only in emergency situations. The use of protective equipment and dental office isolation were the major points to avoid the contact between infected and non-infected patients. Preventive measures should be taken in order to reduce the spread of 2019-nCoV infection.


title: Clinical characteristics of 54 medical staff with COVID‐19: A retrospective study in a single center in Wuhan, China

text: In December 2019, an outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS‐Cov‐2) infection occurred in Wuhan, and rapidly spread to worldwide, which has attracted many people's concerns about the patients. However, studies on the infection status of medical personnel is still lacking. A total of 54 cases of SARS‐Cov‐2 infected medical staff from Tongji Hospital between 7 January and 11 February 2020 were analyzed in this retrospective study. Clinical and epidemiological characteristics were compared between different groups by statistical method. From 7 January to 11 February 2020, 54 medical staff of Tongji Hospital were hospitalized due to coronavirus disease 2019 (COVID‐19). Most of them were from other clinical departments (72.2%) rather than emergency department (3.7%) or medical technology departments (18.5%). Among the 54 patients with COVID‐19, the distribution of age had a significant difference between non‐severe type and severe/critical cases (median age: 47 years vs 38 years; P = .0015). However, there was no statistical difference in terms of gender distribution and the first symptoms between theses two groups. Furthermore, we observed that the lesion regions in SARS‐Cov‐2 infected lungs with severe‐/critical‐type of medical staff were more likely to exhibit lesions in the right upper lobe (31.7% vs 0%; P = .028) and right lung (61% vs 18.2%; P = .012). Based on our findings with medical staff infection data, we suggest training for all hospital staff to prevent infection and preparation of sufficient protection and disinfection materials.


title: Awake tracheal intubation in a suspected COVID-19 patient with critical airway obstruction

text: Summary We report the airway management of a patient suspected of being COVID-19 positive with impending airway obstruction requiring urgent surgical tracheostomy To our knowledge, this is the first reported case of an awake tracheal intubation in a suspected COVID-19 positive patient Various modifications were put in place during the awake tracheal intubation and surgical tracheostomy procedures to minimise aerosol generation from the patient, such as avoiding high flow nasal oxygen, establishing conscious sedation with remifentanil prior to commencing airway topicalisation and avoiding trans-tracheal local anaesthetic infiltration A multidisciplinary team discussion prior to performing the case highlighted aspects of both the airway management and the surgical procedure where particular care and modifications are required There is a lack of national guidance for awake tracheal intubation and tracheostomy in COVID-19 cases This report nevertheless addresses the key procedural modifications required


title: Identification of a conserved linear B-cell epitope in the M protein of porcine epidemic diarrhea virus

text: BACKGROUND: The major structural protein of coronaviruses, the membrane (M) protein, can elicit the formation of protective antibodies, but little information is available about the M protein of porcine epidemic diarrhea virus (PEDV). Identification of epitopes on the PEDV M protein will be helpful in the elucidation of the antigenic properties of this protein. RESULTS: One hybridoma cell line secreting anti-M protein monoclonal antibody (McAb) was generated and designated 4D4. To map the epitopes on the PEDV M protein, a total of 17 partially overlapping fragments covering the C-terminus of M protein were expressed as fusion proteins with a 6×His tag or a GST tag. A linear motif, (193)TGWAFYVR(200), was identified by enzyme-linked immunosorbent assay (ELISA) and western blot (WB) analysis using McAb 4D4. The motif (195)WAFYVR(200) was the minimal requirement for reactivity, as demonstrated by removing amino acids individually from both ends of the motif (193)TGWAFYVR(200). The result of WB analysis showed that the 4D4-defined epitope could be recognized by PEDV-positive serum, but not transmissible gastroenteritis virus (TGEV)-positive serum. Furthermore, this epitope was highly conserved among different PEDV strains, as shown by alignment and comparison of sequences. CONCLUSION: A McAb, 4D4, directed against the M protein of PEDV, was obtained, and the 4D4-defined minimal epitope sequence was (195)WAFYVR(200). The McAb could serve as a candidate for development of a McAb-based antigen capture ELISA for detection of PEDV. The epitope identified provides a basis for the development of epitope-based differential diagnostic techniques and may be useful in the design of epitope-based vaccines.


title: Immune responses to T-cell epitopes of SARS CoV-N protein are enhanced by N immunization with a chimera of lysosome-associated membrane protein

text: In our previous study by Gupta et al, dominant T-cell epitopes of SARS CoV-N(N) protein were predicted by software. The spectrum of interferon (IFN)-γ responses of Balb/c mice immunized against two different forms of SARS CoV-N plasmid was then analyzed. A cluster of dominant T-cell epitopes of SARS CoV-N protein was found in the N-terminus (amino acids 76–114). On the basis of this study, four different plasmids were constructed: (i) DNA encoding the unmodified N (p-N) or N(70−122) (p-N(70−122)) as an endogenous cytoplasmic protein or (ii) DNA encoding a lysosome-associated membrane protein (LAMP) chimera with N (p-LAMP/N) or N(70−122) (p-LAMP/N(70−122)). The immune responses of mice to these four constructs were evaluated. The results showed marked differences in the responses of the immunized mice. A single priming immunization with the p-LAMP/N construct was sufficient to elicit an antibody response. Enzyme-linked immunospot (ELISpot) assay indicated that p-LAMP/N(70−122) and p-LAMP/N plasmids both elicited a greater IFN-γ response than p-N. p-N and p-N(70−122) constructs induced low or undetectable levels of cytokine secretion. We also found that the p-LAMP/N(70−122) construct promoted a long-lasting T-cell memory response without an additional boost 6 months after three immunizations. These findings show that DNA vaccines, even epitope-based DNA vaccines using LAMP as chimera, can elicit both humoral and cellular immune responses.


title: Coronaviruses Detected in Brazilian Wild Birds Reveal Close Evolutionary Relationships with Beta- and Deltacoronaviruses Isolated From Mammals

text: This study showed that the most of the coronaviruses (CoVs) detected in Brazilian wild birds clustered with the mouse hepatitis virus A59 strain, belonging to the BetaCoV group. Furthermore, CoV detected in two different bird species, Amazona vinacea and Brotogeris tirica, clustered with a CoV isolated from Sparrow (SpaCoV HKU17) belonging to a monophyletic group related with the CoVs isolated from swines (PorCoV HKU15), both belonging to the DeltaCoV genus, previously unreported in South America. Considering the risk of inter-species host switching and further adaptation to new hosts, detection in bird species of CoVs closely related to mammal CoVs should warn for the potential emergence of new threatening viruses. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00239-015-9693-9) contains supplementary material, which is available to authorized users.


title: Combining qualitative and quantitative research within mixed method research designs: A methodological review

text: Abstract Objectives It has been argued that mixed methods research can be useful in nursing and health science because of the complexity of the phenomena studied. However, the integration of qualitative and quantitative approaches continues to be one of much debate and there is a need for a rigorous framework for designing and interpreting mixed methods research. This paper explores the analytical approaches (i.e. parallel, concurrent or sequential) used in mixed methods studies within healthcare and exemplifies the use of triangulation as a methodological metaphor for drawing inferences from qualitative and quantitative findings originating from such analyses. Design This review of the literature used systematic principles in searching CINAHL, Medline and PsycINFO for healthcare research studies which employed a mixed methods approach and were published in the English language between January 1999 and September 2009. Results In total, 168 studies were included in the results. Most studies originated in the United States of America (USA), the United Kingdom (UK) and Canada. The analytic approach most widely used was parallel data analysis. A number of studies used sequential data analysis; far fewer studies employed concurrent data analysis. Very few of these studies clearly articulated the purpose for using a mixed methods design. The use of the methodological metaphor of triangulation on convergent, complementary, and divergent results from mixed methods studies is exemplified and an example of developing theory from such data is provided. Conclusion A trend for conducting parallel data analysis on quantitative and qualitative data in mixed methods healthcare research has been identified in the studies included in this review. Using triangulation as a methodological metaphor can facilitate the integration of qualitative and quantitative findings, help researchers to clarify their theoretical propositions and the basis of their results. This can offer a better understanding of the links between theory and empirical findings, challenge theoretical assumptions and develop new theory.


title: Severe Acute Respiratory Syndrome (SARS): Development of Diagnostics and Antivirals

text: abstract: The previously unknown coronavirus that caused severe acute respiratory syndrome (SARS‐CoV) affected more than 8,000 persons worldwide and was responsible for more than 700 deaths during the first outbreak in 2002–2003. For reasons unknown, the SARS virus is less severe and the clinical progression a great deal milder in children younger than 12 years of age. In contrast, the mortality rate can exceed 50% for persons at or above the age of 60. As part of the Sino‐European Project on SARS Diagnostics and Antivirals (SEPSDA), an immune phage‐display library is being created from convalescent patients in a phagemid system for the selection of single‐chain fragment variables (scFv) antibodies recognizing the SARS‐CoV.


A study of persistent viral infections using nude mice and a temperature-sensitive mutant of vesicular stomatitis virus


title: Lack of dyspnea in patients with Covid‐19: another neurological conundrum?

text: One relevant feature of the Covid-19 disease is the absence of dyspnea, described as 'shortness of breath' or 'an unpleasant urge to breathe'. The lack of dyspnea is observed even in the most severe cases, in which subjects present tachypnea and tachycardia. In the Wuhan cohort, 62.4% of severe cases and 46.3% of those who ended up intubated, ventilated or dead did not present dyspnea[1,2].


title: Survival of covid-19 patients requires precise immune regulation: the hypothetical immunoprotective role of nicotinic agonists

text: Summary recent studies have provided novel evidence regarding the effect of nicotine agonists on the prevention or modulation of cytokines storm and reduction of infection. In this study we tried to attempt to address these issues from a therapeutic perspective of nicotine agonists in this manner and we describe one of the most challenging theories of immunotherapy in coronavirus-19 (COV-19). The analysis of the proposed mechanism goes beyond the physiological consequences of a way to design new strategies to provide anti-inflammatory drugs.


title: Synthesis and pharmacological evaluation of several ring-contracted amantadine analogs

text: Abstract The synthesis of several (3-noradamantyl)amines, [(3-noradamantyl)methyl]amines, (3,7-dimethyl-1-bisnoradamantyl)amines, and [(3,7-dimethyl-1-bisnoradamantyl)methyl]amines is reported. They were evaluated against a wide range of viruses and one of them inhibited the cytopathicity of influenza A virus at a concentration similar to that of amantadine. Several of the new polycyclic amines show an interesting activity as NMDA receptor antagonists. A rimantadine analogue displayed significant trypanocidal activity. Moreover, to further characterize the pharmacology of these compounds, their effects on dopamine uptake were also assessed.


title: Influenza

text: Influenza is an infectious respiratory disease that, in humans, is caused by influenza A and influenza B viruses. Typically characterized by annual seasonal epidemics, sporadic pandemic outbreaks involve influenza A virus strains of zoonotic origin. The WHO estimates that annual epidemics of influenza result in ~1 billion infections, 3–5 million cases of severe illness and 300,000–500,000 deaths. The severity of pandemic influenza depends on multiple factors, including the virulence of the pandemic virus strain and the level of pre-existing immunity. The most severe influenza pandemic, in 1918, resulted in >40 million deaths worldwide. Influenza vaccines are formulated every year to match the circulating strains, as they evolve antigenically owing to antigenic drift. Nevertheless, vaccine efficacy is not optimal and is dramatically low in the case of an antigenic mismatch between the vaccine and the circulating virus strain. Antiviral agents that target the influenza virus enzyme neuraminidase have been developed for prophylaxis and therapy. However, the use of these antivirals is still limited. Emerging approaches to combat influenza include the development of universal influenza virus vaccines that provide protection against antigenically distant influenza viruses, but these vaccines need to be tested in clinical trials to ascertain their effectiveness.


title: Gynecological malignancies with asymptomatic SARS-CoV-2 infection during the convalescence of outbreak

text: • COVID-19 has become a global pandemic. • Gynecologic malignancies with lung metastasis should be alert to asymptomatic infection. • Gynecologic malignancies with asymptomatic COVID-19 can be controlled under strict measures.


title: Immune Parameters of Dry Cows Fed Mannan Oligosaccharide and Subsequent Transfer of Immunity to Calves *

text: Abstract The objective of this study was to evaluate the benefits of supplementation of mannan oligosaccharide (MOS) to cows during the last 3 wk of the dry period on immune function of the cows and subsequent transfer of passive immunity to their calves. Indicators of nonspecific and specific immunity were evaluated. Cows were vaccinated against rotavirus at 4 and 2 wk before expected parturition. Blood samples were obtained from cows before vaccination and at weekly intervals until calving and from calves at birth and 24h for analysis of serum protein concentrations, packed cell volume, white blood cell counts, white blood cell differentials, and serum rotavirus neutralization titers. Colostrum quantity and quality were measured at calving, and immunoglobulin isotype concentrations in colostrum were determined. Specific immunity was enhanced by MOS supplementation as evidenced by greater serum rotavirus neutralization titers at calving in cows supplemented with MOS compared with control cows. Colostral rotavirus neutralization titers were not affected by treatment. Although numerical differences appeared large, there was a high degree of variability in the colostral rotavirus neutralization titers. Calves from cows fed MOS tended to have greater serum rotavirus neutralization titers compared with calves from cows fed the control diet. There was a tendency for greater increases in serum protein concentrations from birth to 24h in calves from cows fed MOS compared with calves from cows fed the control diet. Results indicate that supplementation of MOS to cows during the dry period enhanced their immune response to rotavirus and tended to enhance the subsequent transfer of rotavirus antibodies to calves.


Pregnancy and H1N1 infection – Authors' reply


title: Head and neck cancer surgery in COVID-19 pandemic in Northern Italy

text: • The Coronavirus disease 2019 (COVID-2019) pandemic represents a great challenge both in itself and for time-sensitive diseases. • Head and neck cancer surgery is a high risk procedure for COVID-19. • Possibility of SARS-CoV-2 false negative at pre-operative evaluation in asymptomatic subjects should not let guard down in the post-operative time.


title: Epidemiology and clinical features of COVID-19: A review of current literature

text: Abstract Coronavirus disease 2019 is a pandemic influencing the first half of the year 2020. The virus has rapidly spread to many countries. Studies are rapidly published to share information regarding epidemiology, clinical and diagnostic patterns, and prognosis. The following review condenses the surge of information into an organized format.


title: Major head and neck reconstruction during the COVID‐19 pandemic: The University of Pittsburgh approach

text: The 2019 novel coronavirus (COVID‐19) pandemic has created significant challenges to the delivery of care for patients with advanced head and neck cancer requiring multimodality therapy. Performing major head and neck ablative surgery and reconstruction is a particular concern given the extended duration and aerosolizing nature of these cases. In this manuscript, we describe our surgical approach to provide timely reconstructive care and minimize infectious risk to the providers, patients, and families.


title: Targeting of endoplasmic reticulum-associated proteins to axons and dendrites in rotavirus-infected neurons

text: Abstract To analyze sorting and compartmentalization of molecules in neuronal endomembranes, the distribution of endogenous proteins associated with the endoplasmic reticulum (ER), intermediate compartment, the Golgi apparatus in cultures of dorsal root ganglion (DRG), and hippocampal neurons was compared with that of newly synthesized ER-associated rotavirus proteins. The endogenous ER-retained immunoglobulin heavy chain binding protein, protein disulfide isomerase, and a peptide containing the KDEL amino acid sequence appeared in the soma and dendrites up to their first branching, but not in axons. However, two other endogenous ER-associated proteins, calreticulin and calnexin, occurred in axons as well as in the somatodendritic domains. The ER-associated rotavirus proteins, VP7 and NSP4, were widely distributed in cell bodies and dendrites. The former appeared also in axons and its localization partially overlapped with that of calreticulin and calnexin. One intermediate compartment protein, ER-Golgi-intermediate compartment-protein-53 (ERGIC-53), extended beyond the first division of the dendrites and did not, as the small guanosine 5′-triphosphate (GTP)-binding protein rab2, appear in axons. The location of rab2 to small vesicles was distinct from that of rotavirus VP7. Cis /medial Golgi cistern proteins were restricted to the cell bodies and proximal dendrites. This study emphasizes the marked heterogeneity in the targeting to axons and dendrites of proteins associated with ER and intermediate compartments. Therefore, the composition of axonal ER-retained molecules differs from that in the soma and this variation may reflect differences in functions between the ER compartments. Viral proteins are useful reporters for such heterogeneities and rotavirus VP7 may be a tool to reveal sorting signals for targeting of vesicular proteins to axons via a nonclassical Golgi-independent mechanism. Such signals may also determine viral targeting to different regions of the brain.


title: The common cold

text: The common cold continues to be the major cause of absences from school and work. A better understanding of the epidemiology and the natural history should lead to less anxiety about this disease. Although there is still much misinformation among the public, the time should soon come when better-informed patients with this disease will make fewer visits to the physician and will not expect unnecessary and worthless treatment.


title: Squeezing the antibiotic balloon: the impact of antimicrobial classes on emerging resistance

text: ABSTRACT The ongoing problem of emerging antimicrobial resistance has been likened to a balloon where settling one specific issue results in a ‘bulge’ of even worse problems. However, much has been learned about how to best use our critical antibacterial agents in ways to avoid or even repair some of the resistance damage that has been done. A compilation of current literature strongly suggests that to slow the development of resistance to antimicrobial agents it is optimal to use drugs with more than one mechanism of action or target, to prescribe those with demonstrated ability to minimise or reverse resistance problems, and to avoid underdosing of potent antibiotics. The most recent information also indicates that it is best to limit empirical use of β-lactam plus fluoroquinolone combination therapy, since these two classes activate some common resistance responses, and using them together can facilitate multidrug resistance in important pathogens, particularly Pseudomonas aeruginosa and Acinetobacter species. This review discusses the role of each major antimicrobial class on resistance development and presents specific strategies for combating the growing problem of multidrug-resistant bacteria. We now have the knowledge to better manage our antimicrobial agent prescribing practices, but finding the will and resources to apply our understanding remains a formidable challenge.


title: A Review of Coffee By-Products Including Leaf, Flower, Cherry, Husk, Silver Skin, and Spent Grounds as Novel Foods within the European Union

text: The coffee plant Coffea spp. offers much more than the well-known drink made from the roasted coffee bean. During its cultivation and production, a wide variety of by-products are accrued, most of which are currently unused, thermally recycled, or used as animal feed. The aim of this review is to provide an overview of novel coffee products in the food sector and their current legal classification in the European Union (EU). For this purpose, we have reviewed the literature on the composition and safety of coffee flowers, leaves, pulp, husk, parchment, green coffee, silver skin, and spent coffee grounds. Some of these products have a history of consumption in Europe (green coffee), while others have already been used as traditional food in non-EU-member countries (coffee leaves, notification currently pending), or an application for authorization as novel food has already been submitted (husks, flour from spent coffee grounds). For the other products, toxicity and/or safety data appear to be lacking, necessitating further studies to fulfill the requirements of novel food applications.


title: Proposals for managing patients with thoracic malignancies during COVID-19 pandemic

text: Abstract The objective of this document is to formalize a degraded mode management for patients with thoracic cancers in the context of the COVID-19 pandemic. The proposals are based on those of the French High Council for Public Health, on published data outside the context of COVID-19, and on a concerted analysis of the risk-benefit ratio for our patients by a panel of experts specialized on thoracic oncology under the aegis of the French-Language Society of Pulmonology (SPLF) / French-language oncology group. These proposals are evolving (10/04/2020) according to the situations encountered which will enrich it, and are to be adapted to our institutional organisations and to the evolution of resources during the COVID-19 epidemic. Patients with symptoms and/or COVID-19+ are not discussed in this document and are managed within the framework of specific channels.


title: Comparative proteomic analysis of cauliflower under high temperature and flooding stresses

text: Abstract High-temperature and waterlogging are major abiotic stresses that affect the yield and quality of cauliflower. Cauliflower cultivars ‘H41’ and ‘H69’ are tolerant to high temperature and flooding, respectively; however, ‘H71’ is sensitive to both stresses. The objectives of this study were to identify the proteins that were differentially regulated and the physiological changes that occurred during different time periods in ‘H41’, ‘H69’, and ‘H71’ when responding to treatments of flooding, 40°C, and both stresses combined. Changes in the leaf proteome were analyzed by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS) and identified by Mascot peptide mass fingerprint (PMF) and database searching. Stress treatments caused significant reductions in electrolyte leakage, chlorophyll fluorescence Fv/Fm, chlorophyll content, and water potential as stress times were prolonged. By the comparative proteomic analysis, 85 protein peaks that were differentially expressed in response to combination treatments at 0, 6, and 24h, 69 (33 in ‘H41’, 29 in ‘H69’, and 9 in ‘H71’) were identified, of which were cultivar specific. Differentially regulated proteins predominantly functioned in photosynthesis and to a lesser extent in energy metabolism, cellular homeostasis, transcription and translation, signal transduction, and protein biosynthesis. This is the first report that utilizes proteomics to discover changes in the protein expression profile of cauliflower in response to heat and flooding.


title: Population Responses during the Pandemic Phase of the Influenza A(H1N1)pdm09 Epidemic, Hong Kong, China

text: During August 2009–July 2010, we conducted 7 longitudinal telephone surveys among 503 adults in Hong Kong, China, to explore changes in their behavioral and psychological responses to the influenza A(H1N1)pdm09 virus epidemic. Trends were examined using generalized estimating equations models. Findings showed that responses varied with the course of the pandemic.


Unique Patterns of Cardiovascular Involvement in COVID-19


title: Constituents of buriti oil (Mauritia flexuosa L.) like inhibitors of the SARS-Coronavirus main peptidase: an investigation by docking and molecular dynamics

text: Statistics show alarming numbers of infected and killed in the world, caused by the Covid-19 pandemic, which still doesn’t have a specific treatment and effective in combating all efforts to seek treatments and medications against this disease. Natural products are of relevant interest in the search for new drugs. Thus, Buriti oil (Mauritia flexuosa L.) is a natural product extracted from the fruit of the palm and is quite common in the legal Amazon region, Brazil. In the present work, the anti-Covid-19 biological activity of some constituents of Buriti oil was investigated using in silico methods of Molecular Docking and Molecular Dynamics Simulations. The main results of Molecular Docking revealed favorable interaction energies in the formation of the 2GTB peptidase complex (main peptidase of SARS-CoV) with the 13-cis-β-carotene ligands (ΔG(bind) = −10.23Kcal mol(−1)), 9-cis -β-carotene (ΔG(bind) = −9.82Kcal mol(−1)), and α-carotene (ΔG(bind) = −8.34Kcal mol(−1)). Molecular Dynamics simulations demonstrated considerable interaction for these ligands with emphasis on α-carotene. Such theoretical results encourage and enable a direction for experimental studies in vitro and in vivo, essential in the development of new drugs with enzymatic inhibitory action for Covid-19. Communicated by Ramaswamy H. Sarma.


title: Bilateral cardiac sympathetic denervation in children with long-QT syndrome and Cathecholaminergic polymorphic ventricular tachycardia

text: • Left cardiac sympathetic denervation is reported to reduce the rate of events and sudden death in young patients with channelopathy. • Horner syndrome and recurrence can be seen after left cardiac sympatetic denervation. • Bilateral cardiac sympathetic denervation in pediatric patient, is reported as a case report. • As a result of our clinical experience bilateral cardiac sympathetic denervation is effective and safe procedure which reduces recurrence in pediatric patients with channelopathies.


title: Distinct genetic spectrums and evolution patterns of SARS-CoV-2

text: Four signature groups of single-nucleotide variants (SNVs) were identified using two-way clustering method in about twenty thousand high quality and high coverage SARS-CoV-2 complete genome sequences. Some frequently occurred SNVs predominate but are mutually exclusively presented in patients from different countries and areas. These major SNV signatures exhibited distinguished evolution patterns overtime. Although it was rare, our data indicated possible cross-infections with multiple groups of SNVs existed simultaneously in some patients, suggesting infections from different SARS-CoV-2 clades or potential re-combination of SARS-CoV-2 sequences. Interestingly nucleotide substitutions among SARS-CoV-2 genomes tend to occur at the sites where one bat RaTG13 coronavirus sequences differ from Wuhan-Hu-1 genome, indicating the tolerance of mutations on those sites or suggesting that major viral strains might exist between Wuhan-Hu-1 and RaTG13 coronavirus.


title: The International Polar Year, 2007–2008, An Opportunity to Focus on Infectious Diseases in Arctic Regions

text: On 3 occasions over the past 125 years, scientists from around the world have worked together to organize scientific and exploration activities in polar regions (www.ipy.org). The first International Polar Year (IPY) in 1881-1884 marked the first major coordinated international scientific initiative to collect standardized meteorological and geophysical data in polar regions. Fifteen expeditions led by 12 nations amassed a large amount of data, but the scientific value was diminished by disjointed publication efforts and lack of long-term institutional commitment; lessons were learned and corrected in subsequent polar years. The second IPY began in 1932. Forty-four nations led expeditions in the Arctic and Antarctic, resulting in greater understanding of the aurora, magnetism, and meteorology. Air and marine navigation, radio operations, and weather forecasting were greatly improved as a result. The third IPY, in 1957-58, was renamed the International Geophysical Year and capitalized on technologic advances developed during World War II. Technologic and scientific momentum was redirected toward research, particularly to studies of the upper atmosphere, a legacy that continues to the present day. Notable achievements included launching the first satellite, measurement of atmospheric greenhouse gases, delineating the system of mid-ocean ridges, and confirming the theory of plate tectonics.


title: The year in review

text: SUMMARY Over the last year there have been more studies determining predisposition to severe bronchiolitis and its consequences. Studies have highlighted various single-nucleotide polymorphisms (SNPs) to be significantly associated with respiratory syncytial virus (RSV) hospitalisation, and a candidate gene approach demonstrated that innate immune gene SNPs had the strongest association with bronchiolitis. The impact of ‘other’ viruses (RSV, influenza, adenovirus, parainfluenza, rhinovirus, human metapneumovirus [hMPV], coronavirus, boca-virus, enterovirus, paraechovirus) has been investigated. In one series only children with RSV infection experienced recurrent wheezing and in another only RSV infection was associated with respiratory complications (hypoxia correlated with prolonged hospitalisation). Others have examined the long-term outcome of viral infection in infancy. The above studies and others published in the last year will be discussed.


title: Phylogenetic Insight into Zika and Emerging Viruses for a Perspective on Potential Hosts

text: Global viral diversity is substantial, but viruses that contribute little to the public health burden or to agricultural damage receive minimal attention until a seemingly unimportant virus becomes a threat. The Zika virus (ZIKV) illustrated this, as there was limited information and awareness of the virus when it was identified as a public health emergency in February 2016. Predicting which virus may pose a future threat is difficult. This is in part because significant knowledge gaps in the basic biology and ecology of an emerging virus can impede policy development, delay decision making, and hinder public health action. We suggest using a phylogenetic framework of pathogens and their infected host species for insight into which animals may serve as reservoirs. For example, examining flaviviruses closely related to ZIKV, the phylogenetic framework indicates New World monkeys are the most likely candidates to be potential reservoirs for ZIKV. Secondarily, mammals that are in close proximity to humans should be considered because of the increased opportunity for pathogen exchange. The increase in human-mediated environmental change is accelerating the probability of another previously overlooked virus becoming a significant concern. By investing in basic science research and organizing our knowledge into an evolutionary framework, we will be better prepared to respond to the next emerging infectious disease. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10393-017-1237-x) contains supplementary material, which is available to authorized users.


title: Gastrointestinal Diseases of Foals

text: Few foals escape gastrointestinal disease during the first few weeks of life. Nutritional and infectious causes of foal diarrhea are considered from both diagnostic and therapeutic viewpoints. The diagnosis and therapy of gastric and duodenal ulcer disease in foals are also discussed.


title: Middle East respiratory syndrome (MERS) coronavirus and dromedaries

text: Abstract Middle East Respiratory Syndrome (MERS) is a zoonotic viral disease that can be transmitted from dromedaries to human beings. More than 1500 cases of MERS have been reported in human beings to date. Although MERS has been associated with 30% case fatality in human beings, MERS coronavirus (MERS-CoV) infection in dromedaries is usually asymptomatic. In rare cases, dromedaries may develop mild respiratory signs. No MERS-CoV or antibodies against the virus have been detected in camelids other than dromedaries. MERS-CoV is mainly acquired in dromedaries when they are less than 1 year of age, and the proportion of seropositivity increases with age to a seroprevalence of 100% in adult dromedaries. Laboratory diagnosis of MERS-CoV infection in dromedaries can be achieved through virus isolation using Vero cells, RNA detection by real-time quantitative reverse transcriptase-PCR and antigen detection using respiratory specimens or serum. Rapid nucleocapsid antigen detection using a lateral flow platform allows efficient screening of dromedaries carrying MERS-CoV. In addition to MERS-CoV, which is a lineage C virus in the Betacoronavirus (betaCoV) genus, a lineage B betaCoV and a virus in the Alphacoronavirus (alphaCoV) genus have been detected in dromedaries. Dromedary CoV UAE-HKU23 is closely related to human CoV OC43, whereas the alphaCoV has not been detected in human beings to date.


title: Automated vocabulary discovery for geo-parsing online epidemic intelligence

text: BACKGROUND: Automated surveillance of the Internet provides a timely and sensitive method for alerting on global emerging infectious disease threats. HealthMap is part of a new generation of online systems designed to monitor and visualize, on a real-time basis, disease outbreak alerts as reported by online news media and public health sources. HealthMap is of specific interest for national and international public health organizations and international travelers. A particular task that makes such a surveillance useful is the automated discovery of the geographic references contained in the retrieved outbreak alerts. This task is sometimes referred to as "geo-parsing". A typical approach to geo-parsing would demand an expensive training corpus of alerts manually tagged by a human. RESULTS: Given that human readers perform this kind of task by using both their lexical and contextual knowledge, we developed an approach which relies on a relatively small expert-built gazetteer, thus limiting the need of human input, but focuses on learning the context in which geographic references appear. We show in a set of experiments, that this approach exhibits a substantial capacity to discover geographic locations outside of its initial lexicon. CONCLUSION: The results of this analysis provide a framework for future automated global surveillance efforts that reduce manual input and improve timeliness of reporting.


title: Frameshifting RNA Pseudoknots: Structure and Mechanism

text: Programmed ribosomal frameshifting (PRF) is one of multiple translational recoding processes that fundamentally alters triplet decoding of the messenger RNA by the elongating ribosome. The ability of the ribosome to change translational reading frames in the −1 direction (−1 PRF) is employed by many positive strand RNA viruses, including economically important plant viruses and many human pathogens such as retroviruses, e.g., HIV-1, and coronaviruses, e.g., the causative agent of severe acute respiratory syndrome (SARS), in order to properly express their genomes. −1 PRF is programmed by a bipartite signal embedded in the mRNA and includes a heptanucleotide “slip site” over which the paused ribosome “backs up” by one nucleotide, and a downstream stimulatory element, either an RNA pseudoknot or a very stable RNA stem-loop. These two elements are separated by 6–8 nucleotides, a distance that places the 5′ edge of the downstream stimulatory element in direct contact with the mRNA entry channel of the 30S ribosomal subunit. The precise mechanism by which the downstream RNA stimulates −1 PRF by the translocating ribosome remains unclear. This review summarizes the recent structural and biophysical studies of RNA pseudoknots and places this work in the context of our evolving mechanistic understanding of translation elongation. Support for the hypothesis that the downstream stimulatory element provides a kinetic barrier to the ribosome mediated unfolding is discussed.


title: The mannose-binding lectin: a prototypic pattern recognition molecule

text: The innate immune system is comprised of a sophisticated network of recognition and effector molecules that act together to protect the host in the first minutes or hours of exposure to an infectious challenge. The mannose-binding lectin (MBL) is an evolutionary conserved circulating host defense protein that acts as a broad-spectrum recognition molecule against a wide variety of infectious agents. Target binding triggers the MBL pathway of complement activation. MBL can be considered conceptually as an ‘ante-antibody’ because it has a role in mammals during the lag period that is required to develop an antibody response against infectious agents. Additionally, there are MBL-like homologues in animals that lack adaptive immunity that activate a primitive complement system, and under these circumstances these MBL-like molecules play an analogous role to antibodies in higher animals. These molecules might be considered to be functional antecedents of antibodies. Recent work also indicates that MBL recognizes altered self-antigens, and as such MBL has a role that extends beyond a traditional role in first line host defense as it appears to play a role as a modulator of inflammation.


title: The Korean Influenza National Immunization Program: History and Present Status

text: The Korean influenza national immunization program was first established as an interim program in 1997, administering the influenza vaccine to low-income elderly adults. In 2005, the program assumed its present form of providing free influenza vaccination to adults aged ≥65 years. After turning over the influenza vaccination for elderly adults to the private sectors in 2015, the influenza vaccination coverage rate among this population increased to >80%. In addition, after the 2009 H1N1 influenza epidemic crisis, the vaccine was domestically produced. By reaching a 75% vaccination coverage rate in the target groups, it was possible to put an end to the influenza pandemic and fix the shortcomings of the system that existed at that time. The influenza vaccination program, provided free of cost, was extended to include infants aged <12 months in 2016 and ≤59 months in 2017 in order to reduce the influenza burden in these populations. However, the vaccine effectiveness remains low despite the high vaccination rates in elderly adults. Therefore, several areas, such as the adoption of quadrivalent influenza vaccine, adjuvanted influenza vaccine, and high-dose influenza vaccine and the expansion of vaccination target groups, still need to be addressed.


Letter to the Editor: “Our Response to COVID-19 as Endocrinologists and Diabetologists”


title: Immunoperoxidase tracing of Junin virus neural route after footpad inoculation

text: To determine the pathway adopted by peripherally inoculated Junin virus (JV) to reach the CNS, rat tissues were serially harvested to trace the sequence of viral progression from right hind footpad to brain. Immunoperoxidase (PAP) labeling of viral antigen, concomitantly with infectivity assays and histological examination of each selected sample, were carried out. As from the 2nd week post-infection (pi), neurological disease inducing 100% mortality at 1 month was evident. At day 5 pi, viral antigen was first detected at footpad level in epidermic and dermic cells, as well as in neighbouring myocytes; labeled macrophages infiltrating small nerve branches were also disclosed. As from 10–15 days pi, viral antigen became apparent along ipsilateral sciatic nerve structures and within lumbar spinal ganglion neurons, followed by a fast viral spread throughout CNS neurons that involved spinal cord and brain. Concurrent histopathology featured minimal inflammatory reaction together with generalized astrocytic activation. Hematogenous viral transport was negligible, since JV was isolated much earlier and in higher infectivity titers in neural tissues than in blood. It may be concluded that after viral replication in footpad, JV neural route was demonstrated by its PAP labeling from peripheral nerves to cerebral cortex.


title: An effective strategy for recapitulating N-terminal heptad repeat trimers in enveloped virus surface glycoproteins for therapeutic applications

text: Sequestering peptides derived from the N-terminal heptad repeat (NHR) of class I viral fusion proteins into a non-aggregating trimeric coiled-coil conformation remains a major challenge. Here, we implemented a synthetic strategy to stabilize NHR-helical trimers, with the human immunodeficiency virus type 1 (HIV-1) gp41 fusion protein as the initial focus. A set of trimeric scaffolds was realized in a synthetic gp41 NHR-derived peptide sequence by relying on the tractability of coiled-coil structures and an additional isopeptide bridge-tethering strategy. Among them, (N36M)(3) folded as a highly stable helical trimer and exhibited promising inhibitory activity against HIV-1 infection, exceptional resistance to proteolysis, and effective native ligand-binding capability. We anticipate that the trimeric coiled-coil recapitulation methodology described herein may have broader applicability to yield NHR trimers of other class I enveloped viruses and to prepare helical tertiary structure mimetics of certain natural protein–protein interactions for biomedical applications.


title: Optimization and validation of sample preparation for metagenomic sequencing of viruses in clinical samples

text: BACKGROUND: Sequence-specific PCR is the most common approach for virus identification in diagnostic laboratories. However, as specific PCR only detects pre-defined targets, novel virus strains or viruses not included in routine test panels will be missed. Recently, advances in high-throughput sequencing allow for virus-sequence-independent identification of entire virus populations in clinical samples, yet standardized protocols are needed to allow broad application in clinical diagnostics. Here, we describe a comprehensive sample preparation protocol for high-throughput metagenomic virus sequencing using random amplification of total nucleic acids from clinical samples. RESULTS: In order to optimize metagenomic sequencing for application in virus diagnostics, we tested different enrichment and amplification procedures on plasma samples spiked with RNA and DNA viruses. A protocol including filtration, nuclease digestion, and random amplification of RNA and DNA in separate reactions provided the best results, allowing reliable recovery of viral genomes and a good correlation of the relative number of sequencing reads with the virus input. We further validated our method by sequencing a multiplexed viral pathogen reagent containing a range of human viruses from different virus families. Our method proved successful in detecting the majority of the included viruses with high read numbers and compared well to other protocols in the field validated against the same reference reagent. Our sequencing protocol does work not only with plasma but also with other clinical samples such as urine and throat swabs. CONCLUSIONS: The workflow for virus metagenomic sequencing that we established proved successful in detecting a variety of viruses in different clinical samples. Our protocol supplements existing virus-specific detection strategies providing opportunities to identify atypical and novel viruses commonly not accounted for in routine diagnostic panels. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40168-017-0317-z) contains supplementary material, which is available to authorized users.


title: Expansion of Hospital‐Based Blood Collections in the Face of COVID‐19 Associated National Blood Shortage

text: BACKGROUND: When the coronavirus pandemic caused widespread school and business closures in March 2020, blood drives were cancelled and the supply of blood decreased suddenly in the United States (US). In response, hospital‐based transfusion medicine physicians instituted policies to conserve blood and decrease blood product usage. These efforts were aided by the US Surgeon General recommendation to cancel all elective procedures. Nevertheless, the duration, severity, and impact of the pandemic on the national blood supply was uncertain. Hospitals with in‐house donor programs had the opportunity not only to control demand, but also increase supply. STUDY DESIGN AND METHODS: A hospital‐based blood donor center was rapidly mobilized to increase the supply of in‐house collected blood, in order to counteract a sudden but potentially long‐term depletion of the national blood supply during a pandemic. RESULTS: Collections increased approximately five‐fold above baseline for whole blood units, while apheresis platelet units were maintained at the historical average for the blood donor center. Cancellation of elective procedures showed a modest, but not yet statistically significant decrease in average blood product usage per day, nevertheless the in‐house collection rate was sufficient to meet demand. CONCLUSION: A hospital‐based blood donor center can quickly increase collection volumes and capacity in the face of a national emergency / pandemic. The desire to collect units should be balanced with safety concerns, need for sustainability, and blood product demand. This article is protected by copyright. All rights reserved.


title: Knowledge, perception, performance, and attitude regarding hand hygiene and related factors among infection control nurses in South Korea: A cross-sectional study

text: BACKGROUND: We assessed the current status of knowledge, perception, attitude, and role model regarding hand hygiene (HH) among infection control nurses (ICNs) and identified the factors influencing these variables. METHODS: A structured questionnaire was adapted from a World Health Organization survey. Data were collected from November 8, 2017, to February 2, 2018. RESULTS: ICNs showed the following scores (mean ± SD): knowledge (19.5 ± 2.3), perception (69.9 ± 8.9), attitude (46.9 ± 5.8), and role model (39.2 ± 6.0). HH performance of health care workers (HCWs) was 75.2 ± 15.5. Mean HH performance scores of HCWs (P = .007) differed significantly according to infection control experience (3 groups: ≤12 months, 13-24 months, >24 months). Perception, attitude, and role model scores showed positive correlations with each other (P < .01). The regression model for HH performance of HCWs was calculated as follows: Y(1) = 31.638 + 0.067X(1) (perception of ICNs) + 0.133X(2) (attitude of ICNs) + 0.825X(3) (role model of ICNs) (P < .001; adjusted R(2) = 0.115). DISCUSSION: Perception, attitude, and role model scores of ICNs were significant predictors of HH performance of HCWs. CONCLUSIONS: Specialized well-structured HH education programs should be developed for ICNs that will help improve HH performance of HCWs.


title: Virulence, antimicrobial resistance and phylogenetic analysis of zoonotic walking pneumonia Mycoplasma arginini in the one-humped camel (Camelus dromedarius)

text: Abstract In the scientific literature, a small amount of information is found concerning mycoplasmosis in camel species. A variety of pathogens could be causative agents for pneumonia, but walking pneumonia is mostly caused by Mycoplasma with slow development and mild symptoms. The aim of this study was to identify mycoplasmas from camels (Camelus dromedarius) and extending the arsenal of factors implicated in pathogenicity of M. arginini to shed light on the current knowledge gap. 460 lung samples (pneumonic; n=210 and apparently healthy; n=250) were randomly collected from the one-humped camels (C. domedarius) that have been imported from Sudan and slaughtered at Cairo Slaughterhouse. 48 out of 210 isolates (22.9%) recovered from the pneumonic lungs were recorded as M. arginini. Positive PCR results were obtained for all 48 isolates. On the other hand, infection with the organism was not detected in the apparently healthy lungs. Hemolysis and hydrogen sulphide (H2S) production, a compound that has previously not been identified as a virulence factor in M. arginini, was evident in 100% of the isolates. The 48 M. arginini isolates were weak in their ability to form biofilm on polystyrene surfaces. All isolates were 100% susceptible to florfenicol and streptomycin and 100% resistant to ciprofloxacin. Resistance to lincomycin, spiromycin, tylosin, doxacyclin and erythromycin was observed at different frequencies. 13 different combinations of antibiotics representing one to four classes were evident with the Macrolide erythromycin being the most represented. It also should be noted that the ciprofloxacin, doxacyclin, lincomycin, erythromycin combination was the most noted in 21/48 isolates. Surprisingly, none of the virulence genes (vsp, uvrC and gapA) and quinolone resistance genes (parC and gyrA) were detected by PCR.