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Association of Myocarditis With BNT162b2 Messenger RNA COVID-19 Vaccine in a Case Series of Children

Importance: The BNT162b2 (Pfizer-BioNTech) messenger RNA COVID-19 vaccine was authorized on May 10, 2021, for emergency use in children aged 12 years and older. Initial reports showed that the vaccine was well tolerated without serious adverse events; however, cases of myocarditis have been reported since approval. Objective: To review results of comprehensive cardiac imaging in children with myocarditis after COVID-19 vaccine. Design, Setting, and Participants: This study was a case series of children younger than 19 years hospitalized with myocarditis within 30 days of BNT162b2 messenger RNA COVID-19 vaccine. The setting was a single-center pediatric referral facility, and admissions occurred between May 1 and July 15, 2021. Main Outcomes and Measures: All patients underwent cardiac evaluation including an electrocardiogram, echocardiogram, and cardiac magnetic resonance imaging. Results: Fifteen patients (14 male patients [93%]; median age, 15 years [range, 12-18 years]) were hospitalized for management of myocarditis after receiving the BNT162b2 (Pfizer) vaccine. Symptoms started 1 to 6 days after receipt of the vaccine and included chest pain in 15 patients (100%), fever in 10 patients (67%), myalgia in 8 patients (53%), and headache in 6 patients (40%). Troponin levels were elevated in all patients at admission (median, 0.25 ng/mL [range, 0.08-3.15 ng/mL]) and peaked 0.1 to 2.3 days after admission. By echocardiographic examination, decreased left ventricular (LV) ejection fraction (EF) was present in 3 patients (20%), and abnormal global longitudinal or circumferential strain was present in 5 patients (33%). No patient had a pericardial effusion. Cardiac magnetic resonance imaging findings were consistent with myocarditis in 13 patients (87%) including late gadolinium enhancement in 12 patients (80%), regional hyperintensity on T2-weighted imaging in 2 patients (13%), elevated extracellular volume fraction in 3 patients (20%), and elevated LV global native T1 in 2 patients (20%). No patient required intensive care unit admission, and median hospital length of stay was 2 days (range 1-5). At follow-up 1 to 13 days after hospital discharge, 11 patients (73%) had resolution of symptoms. One patient (7%) had persistent borderline low LV systolic function on echocardiogram (EF 54%). Troponin levels remained mildly elevated in 3 patients (20%). One patient (7%) had nonsustained ventricular tachycardia on ambulatory monitor. Conclusions and Relevance: In this small case series study, myocarditis was diagnosed in children after COVID-19 vaccination, most commonly in boys after the second dose. In this case series, in short-term follow-up, patients were mildly affected. The long-term risks associated with postvaccination myocarditis remain unknown. Larger studies with longer follow-up are needed to inform recommendations for COVID-19 vaccination in this population.

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Intragastric balloon as an adjunct to lifestyle intervention: a randomized controlled trial.

BACKGROUND/OBJECTIVES This trial evaluated the safety and effectiveness of the Orbera Intragastric Balloon as an adjunct to lifestyle intervention. SUBJECTS/METHODS In this multicenter, randomized, open-label clinical trial, 255 adults with a body mass index of 30-40 kg m-2 were treated and outcomes were assessed up to 12 months. Participants were randomized to endoscopic placement of an intragastric balloon plus lifestyle or lifestyle intervention alone. Balloons were removed at 6 months and lifestyle intervention continued for both groups through 12 months. At 9 months, coprimary end points were two measures of weight loss. RESULTS At 6 months, weight loss was -3.3% of total body weight (-3.2 kg) in the lifestyle arm vs -10.2% (-9.9 kg) in the balloon plus lifestyle arm (P<0.001); at 9 months (3 months postballoon removal), weight loss was -3.4% (-3.2 kg) vs -9.1% (-8.8 kg, P⩽0.001); and at 12 months, -3.1% (-2.9 kg) vs -7.6% (-7.4 kg, P⩽0.001). For the primary end points, at 9 months, mean percent loss of weight in excess of ideal body weight (s.d.) at 9 months was 26.5% (20.7) (P=0.32) and 9.7% (15.1) in the balloon and control groups, respectively. Also, 45.6% (36.7, 54.8) of the subjects randomized to the balloon achieved at least 15% loss of weight in excess of ideal body weight greater than the control group (P<0.001). The majority of balloon subjects experienced adverse events; 86.9% nausea, 75.6% vomiting, 57.5% abdominal pain and 18.8% had their device removed before 6 months because of an adverse event or subject request. Five subjects (3.1%) in the balloon group had a gastric abnormality at the time of device removal, and no ulcers were found. CONCLUSIONS AND RELEVANCE Intragastric balloon achieved greater short-term weight loss at 3 and 6 months postballoon removal than lifestyle intervention alone. Adverse gastrointestinal events were common.

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Comparable endemic coronavirus nucleoprotein-specific antibodies in mild and severe Covid-19 patients

The severity of disease of Covid-19 is highly variable, ranging from asymptomatic to critical respiratory disease and death. Potential cross-reactive immune responses between SARS-CoV-2 and endemic coronavirus (eCoV) may hypothetically contribute to this variability. We herein studied if eCoV nucleoprotein (N)-specific antibodies in the sera of patients with mild or severe Covid-19 are associated with Covid-19 severity. There were comparable levels of eCoV N-specific antibodies early and during the first month of infection in Covid-19 patients with mild and severe symptoms, and healthy SARS-CoV-2-negative subjects. These results warrant further studies to investigate the potential role of eCoV-specific antibodies in immunity to SARS-CoV-2 infection.

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The Role of the Oral Microbiota Related to Periodontal Diseases in Anxiety, Mood and Trauma- and Stress-Related Disorders

The prevalence of anxiety, mood and trauma- and stress-related disorders are on the rise; however, efforts to develop new and effective treatment strategies have had limited success. To identify novel therapeutic targets, a comprehensive understanding of the disease etiology is needed, especially in the context of the holobiont, i.e., the superorganism consisting of a human and its microbiotas. Much emphasis has been placed on the role of the gut microbiota in the development, exacerbation, and persistence of psychiatric disorders; however, data for the oral microbiota are limited. The oral cavity houses the second most diverse microbial community in the body, with over 700 bacterial species that colonize the soft and hard tissues. Periodontal diseases encompass a group of infectious and inflammatory diseases that affect the periodontium. Among them, periodontitis is defined as a chronic, multi-bacterial infection that elicits low-grade systemic inflammation via the release of pro-inflammatory cytokines, as well as local invasion and long-distance translocation of periodontal pathogens. Periodontitis can also induce or exacerbate other chronic systemic inflammatory diseases such as atherosclerosis and diabetes and can lead to adverse pregnancy outcomes. Recently, periodontal pathogens have been implicated in the etiology and pathophysiology of neuropsychiatric disorders (such as depression and schizophrenia), especially as dysregulation of the immune system also plays an integral role in the etiology and pathophysiology of these disorders. This review will discuss the role of the oral microbiota associated with periodontal diseases in anxiety, mood and trauma- and stress-related disorders. Epidemiological data of periodontal diseases in individuals with these disorders will be presented, followed by a discussion of the microbiological and immunological links between the oral microbiota and the central nervous system. Pre-clinical and clinical findings on the oral microbiota related to periodontal diseases in anxiety, mood and trauma- and stress-related phenotypes will be reviewed, followed by a discussion on the bi-directionality of the oral-brain axis. Lastly, we will focus on the oral microbiota associated with periodontal diseases as a target for future therapeutic interventions to alleviate symptoms of these debilitating psychiatric disorders.

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Improving Generalizability in Limited-Angle CT Reconstruction with Sinogram Extrapolation

Computed tomography (CT) reconstruction from X-ray projections acquired within a limited angle range is challenging, especially when the angle range is extremely small. Both analytical and iterative models need more projections for effective modeling. Deep learning methods have gained prevalence due to their excellent reconstruction performances, but such success is mainly limited within the same dataset and does not generalize across datasets with different distributions. Hereby we propose ExtraPolationNetwork for limited-angle CT reconstruction via the introduction of a sinogram extrapolation module, which is theoretically justified. The module complements extra sinogram information and boots model generalizability. Extensive experimental results show that our reconstruction model achieves state-of-the-art performance on NIH-AAPM dataset, similar to existing approaches. More importantly, we show that using such a sinogram extrapolation module significantly improves the generalization capability of the model on unseen datasets (e.g., COVID-19 and LIDC datasets) when compared to existing approaches. © 2021, Springer Nature Switzerland AG.

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Quantitative analysis of particulate matter release during orthodontic procedures: a pilot study

Introduction Transmission of SARS-CoV-2 through aerosol has been suggested, particularly in the presence of highly concentrated aerosols in enclosed environments. It is accepted that aerosols are produced during a range of dental procedures, posing potential risks to both dental practitioners and patients. There has been little agreement concerning aerosol transmission associated with orthodontics and associated mitigation. Methods Orthodontic procedures were simulated in a closed side-surgery using a dental manikin on an acrylic model using composite-based adhesive. Adhesive removal representing debonding was undertaken using a 1:1 contra-angle handpiece (W&H Synea Vision WK-56 LT, Bürmoos, Austria) and fast handpiece with variation in air and water flow. The removal of acid etch was also simulated with the use of combined 3-in-1 air-water syringe. An optical particle sizer (OPS 3330, TSI Inc., Minnesota, USA) and a portable scanning mobility particle sizer (NanoScan SMPS Nanoparticle Sizer 3910, TSI Inc., Minnesota, USA) were both used to assess particulate matter ranging in dimension from 0.08 to 10 μm. Results Standard debonding procedure (involving air but no water) was associated with clear increase in the 'very small' and 'small' (0.26-0.9 μm) particles but only for a short period. Debonding procedures without supplementary air coolant appeared to produce similar levels of aerosol to standard debonding. Debonding in association with water tended to produce large increases in aerosol levels, producing particles of all sizes throughout the experiment. The use of water and a fast handpiece led to the most significant increase in particles. Combined use of the 3-in-1 air-water syringe did not result in any detectable increase in the aerosol levels. Conclusions Particulate matter was released during orthodontic debonding, although the concentration and volume was markedly less than that associated with the use of a fast handpiece. No increase in particulates was associated with prolonged use of a 3-in-1 air-water syringe. Particulate levels reduced to baseline levels over a short period (approximately five minutes). Further research within alternative, open environments and without air exchange systems is required.

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Effect of COVID-19 on the Working of a Tertiary Care Hospital

OBJECTIVE: To evaluate the effect of COVID-19 on the working of a tertiary care hospital. STUDY DESIGN: Audit study. PLACE AND DURATION OF STUDY: Services Hospital, Lahore from 1st March to 30th June 2020. METHODOLOGY: We calculated and compared various parameters of hospital working. Two time periods were selected. The study period was defined as the time after first confirmed case of COVID-19 in Pakistan. The control period was defined as one year prior to the first case being reported, taken from 1st March 2019 to 29th February, 2020. The parameters we studied included were number of number of hospital admissions, emergency patients, OPD patients, major surgeries, total surgeries, radiological investigations done, laboratory investigations done, births and mortalities. All parameters were calculated by taking monthly average during each time period and then compared. RESULTS: A decrease in almost all parameters was seen when the cases of the two time periods were compared. There was a decrease in the average hospital admission by 51%, while the patients seen in OPD fell by almost 60%. A slight decrease of 25% was seen in the cases presenting to the emergency. The most marked decrease was in the elective surgeries, which was 66% closely followed by average monthly mortality which decreased by 64%. Average monthly minor surgeries and births were decreased by 33% and 35%, respectively. CONCLUSION: There had been a decrease in the number of patients presenting to the hospital across the board with the most marked increase being in elective surgeries. Key Words: COVID-19, Hospital working, Patient load, Elective surgery.

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[Transfemoral transcatheter aortic valve implantation under conscious sedation. Experience in 15 patients].

BACKGROUND Transfemoral transcatheter aortic valve implantation (TAVI) is the standard of treatment for patients with symptomatic severe aortic stenosis (AE) and intermediate or high surgical risk. The use of conscious sedation (CS) could reduce complications and allow an early discharge of these patients. AIM To report our experience with TAVI under conscious sedation. MATERIAL AND METHODS Review of medical records of 15 patients aged 79 ± 6 years (53% women) undergoing a transfemoral TAVI implant under conscious sedation. RESULTS The indications for the procedure were severe AE in 13 patients and biological prosthetic dysfunction in two. The mean Thoracic Surgeons predicted risk of mortality score was 7.3. The valves used were Edwards Sapien 3 in three patients, Medtronic Evolut in five, Boston Acurate Neo in four and Meril Myval in three. A successful implant was achieved in all cases and there were no hospital mortality or pacemaker requirements. One patient had a stroke, and one patient had a vascular access complication. Early discharge (< 72 h) was achieved in 80% of patients. CONCLUSIONS TAVI under conscious sedation was a safe procedure and associated with a complication rate similar to previous reports, allowing for an early hospital discharge in most patients.

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The use of online video consultations in the aftercare of orthopedic patients: a prospective case-control study

BACKGROUND: Video consultations have proven to be an efficient source of support for patient-doctor interactions and have become increasingly used in orthopedics, especially during the COVID-19 pandemic. This study analyzed both patients’ and doctors’ acceptance of an orthopedic telemedical consultation (OTC) and compared the results of OTC examinations to the results of live consultation (LC) to identify discrepancies. METHODS: The study was carried out in an orthopedic department of a German hospital between 2019 and 2020. After written informed consent was obtained, patients voluntarily presented for follow-up by OTC and LC. The experience with and attitudes toward OTC among both patients and doctors was evaluated (using Likert scale-scored and open questions, 26 to 28 items). The results of the OTC and LC examinations were compared using a 12-item checklist. The data were analyzed by quantitative and qualitative statistics. RESULTS: A total of 53 patients were included, each of whom completed an OTC and an LC. The OTC was rated as pleasant, and the experience was rated as very satisfying (average rating on a 5-point Likert scale, with 1 indicating strong agreement: doctors: 1.2; patients: 1.3). Various technical and organizational challenges were identified. Compared to LC, OTC showed no significant differences in patient history or in inspection, palpation, or active range of motion results. Only for the functional or passive joint assessment did LC show significantly higher suitability (p < 0.05) than OTC. Recommendations for further procedures did not differ significantly between OTC and LC. CONCLUSIONS: Because of the high acceptance and the objective benefits of OTC and the similarity of clinical results with LC, OTC is recommendable for orthopedic follow-up examinations. To better assess joint functionality, meaningful digital alternatives for established examination methods should be further investigated. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-021-04653-3.

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SMA micro-hand implemented in small robot for generating gestures

Research on robots that can be used for communication with humans has become popular in recent years. Communication robots should ideally be as small as an infant in order to reduce the user’s feeling of threat. In addition, non-verbal communication (such as gestures) is also important in facilitating smooth interactions between humans and robots. There are currently a few communication robots that are small sized and can generate hand gestures. In this paper, we propose a small robot hand, which is optimized for gesture communication by using a shape memory alloy (SMA). The SMA employed is a Ti–Ni alloy, which is used as an actuator. The SMA shrinks when it transforms into the austenite phase at temperatures higher than the transformation temperature. When it is in the martensitic phase at a lower temperature, it is expanded by an external force. Each finger of the robot hand is driven by an individual SMA wire. The specifications of the small robot including the hand size, operation angles in each finger joint, response times and power consumption were determined according to the human finger and existing small communication robots. These required specifications have been fulfilled by carefully designing the geometry and heating/cooling power control. A questionnaire-based survey was also conducted with a robot hand. The five-finger hand was successfully shown to generate recognizable symbolic gestures. SUPPLEMENTARY INFORMATION: The online version supplementary material available at 10.1007/s11370-021-00364-9.

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New Device for Securing Nasotracheal Intubation Tube During Oral and Maxillofacial Surgery.

Since 2018, we have been using a 3D printer to fabricate a proprietary device for fixing nasotracheal tubes. The aim of this retrospective study was to investigate the impact of this nasotracheal intubation (NTI) fixation device. It has been used in 335 patients undergoing general anesthesia for oral and maxillofacial surgeries. No necrosis or permanent tissue damage was observed, and none of the patients developed complications requiring treatment. No unintentional tube-related incidents such as extubation, dislocation of the tube, or disconnection between the tube and the artificial respiration circuit occurred either. This fixation device offers three advantages: safety, no impediment to surgery, and minimal invasiveness. Of these, safety is the most important. The high degree of immobilization it offers makes it possible to prevent injury to the nasal ala when the tracheal tube is tugged to the cranial side. There is also a high degree of immobilization at the connection site between the tracheal tube and anesthesia circuit, making it possible to prevent disconnection due to intraoperative pressure. In addition, safety during fixation is less likely to differ depending on the degree of proficiency of the individual anesthesiologist. The presence of a groove through which the sampling tube of the capnometer can be passed makes it possible to prevent the problem of flexion of the sampling tube, rendering detection impossible during surgery. Thus, use of this fixation device offers the potential to improve immobilization of the tracheal tube and increase intraoperative safety. However, there remain several problems that need to be addressed with this novel device. Further improvements aimed at enhancing safety are planned, therefore.

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Flow Diversion for Intracranial Aneurysm Management: A New Standard of Care.

Endovascular treatment of intracranial aneurysms with complex morphologies such as giant, wide-necked, or fusiform aneurysms is challenging. Stent-assisted coiling and balloon-assisted coiling are alternative techniques to treat such complex aneurysms, but studies have shown less-than-expected efficacy, as suggested by their high rate of recanalization. The management of complex aneurysms via microsurgery or conventional neuroendovascular strategies has traditionally been poor. However, over the last few years, flow-diverting stents (FDS) have revolutionized the treatment of such aneurysms. FDS are implanted within the parent artery rather than the aneurysm sac. By modifying intra-aneurysmal and parent-vessel flow dynamics at the aneurysm/parent vessel interface, FDS trigger a cascade of gradual intra-aneurysmal thrombosis. As endothelialization of the FDS is complete, the parent vessel reconstructs while preserving the patency of normal perforators and side branch vessels. As with any intervention, the practice and application of flow-diversion technology is inherent, with risks that include vessel rupture or perforation, in-stent thrombosis, perforator occlusion, procedural and delayed hemorrhages, and perianeurysmal edema. Herein, we review the devices, their mechanisms of actions, clinical applications, complications, and ongoing studies.

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New disease and old threats: A case series of COVID-19 and tuberculosis coinfection in Saudi Arabia

Abstract COVID-19 and TB coinfection are not common and may occur more in TB endemic countries However, patients with pre-COVID-19 chronic respiratory symptoms should be screened for TB as well

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Randomized Clinical Trial to Evaluate a Routine Full Anticoagulation Strategy in Patients with Coronavirus Infection (SARS-CoV2) Admitted to Hospital: Rationale and Design of the ACTION (AntiCoagulaTlon cOroNavirus)–Coalition IV Trial

BACKGROUND: : Observational studies have suggested a higher risk of thrombotic events in patients with coronavirus disease 2019 (COVID-19). Moreover, elevated D-dimer levels have been identified as an important prognostic marker in COVID-19 directly associated with disease severity and progression. Prophylactic anticoagulation for hospitalized COVID-19 patients might not be enough to prevent thrombotic events; therefore, therapeutic anticoagulation regimens deserve clinical investigation. DESIGN: : ACTION is an academic-led, pragmatic, multicenter, open-label, randomized, phase IV clinical trial that aims to enroll around 600 patients at 40 sites participating in the Coalition COVID-19 Brazil initiative. Eligible patients with a confirmed diagnosis of COVID-19 with symptoms up to 14 days and elevated D-dimer levels will be randomized to a strategy of full-dose anticoagulation for 30 days with rivaroxaban 20 mg once daily (or full-dose heparin if oral administration is not feasible) versus standard of care with any approved venous thromboembolism (VTE) prophylaxis regimen during hospitalization. A confirmation of COVID-19 was mandatory for study entry, based on specific tests used in clinical practice (RT-PCR, antigen test, IgM test) collected before randomization, regardless of in the outpatient setting or not. Randomization will be stratified by clinical stability at presentation. The primary outcome is a hierarchical analysis of mortality, length of hospital stay, or duration of oxygen therapy at the end of 30 days. Secondary outcomes include the World Health Organization's 8-point ordinal scale at 30 days and the following individual efficacy outcomes: incidence of VTE, acute myocardial infarction, stroke, systemic embolism, major adverse limb events, duration of oxygen therapy, disease progression, and biomarkers. The primary safety outcomes are major or clinically relevant non-major bleeding according to the International Society on Thrombosis and Haemostasis criteria. SUMMARY: : The ACTION trial will evaluate whether in-hospital therapeutic anticoagulation with rivaroxaban for stable patients, or enoxaparin for unstable patients, followed by rivaroxaban through 30 days compared with standard prophylactic anticoagulation improves clinical outcomes in hospitalized patients with COVID-19 and elevated D-dimer levels. CLINICALTRIALS.GOV: : NCT04394377.

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Non-shef2 model related containment and control measures against covid-19 in Africa

COVID-19 Pandemic has the potential to overwhelm the underserved health care systems of African countries characterized by inadequate infrastructure and too few medical personnel In responding to the COVID-19 Pandemic, many African countries are using a combination of containment and mitigation activities but in this commentary, we focus on what we term the Non-SHEF2 (S: Social distancing, H: Hands, E: Elbows, F: Face, F: Feel) model related control and containment measures which include seven key measures against COVID-19 doped ‘TITHQC2’ namely, T: Travel-related measures, I: Information and guidance, T: Treatment;H: Hospital containment measures;Q: Quarantine, C: Community containment measures, C: Case detection and contact tracing COVID-19 is a reality and demands rapid and decisive action to be taken © Frankline Sevidzem Wirsiy et al

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Spillover of COVID-19: Impact on the Global Economy

How did a health crisis translate to an economic crisis? Why did the spread of the coronavirus bring the global economy to its knees? The answer lies in two methods by which coronavirus stifled economic activities. First, the spread of the virus encouraged social distancing which led to the shutdown of financial markets, corporate offices, businesses and events. Second, the exponential rate at which the virus was spreading, and the heightened uncertainty about how bad the situation could get, led to flight to safety in consumption and investment among consumers, investors and international trade partners. We focus on the period from the start of 2020 through March when the coronavirus began spreading into other countries and markets. We draw on real-world observations in assessing the restrictive measures, monetary policy measures, fiscal policy measures and the public health measures that were adopted during the period. We empirically examine the impact of social distancing policies on economic activities and stock market indices. The findings reveal that the increasing number of lockdown days, monetary policy decisions and international travel restrictions severely affected the level of economic activities and the closing, opening, lowest and highest stock price of major stock market indices. In contrast, the imposed restriction on internal movement and higher fiscal policy spending had a positive impact on the level of economic activities, although the increasing number of confirmed coronavirus cases did not have a significant effect on the level of economic activities.

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Alloimmune Response After SARS-CoV-2 Vaccination in Lung Transplant

Purpose The effect of SARS-CoV-2 vaccination on de novo donor specific antibodies (dnDSA) in lung transplant recipients (LTRs) is unknown. We reviewed dnDSA results following SARS-CoV-2 vaccination in LTRs based on SARS-CoV-2 IgG response. Methods LTRs were tested for SARS-COV-2 Multi-target IgG at 3 and 6 months post-vaccination. LTRs who received at least 1 dose of SARS-CoV-2 vaccine between 12/01/2020 to 07/01/2021 were included in this retrospective review. We compared patients based on anti-spike (S-IgG) results. Results We reviewed 55 LTR charts with S-IgG results. Only 24 (44%) developed S-IgG by 6 months after vaccination. Differences between S-IgG positive and negative groups are shown in the table. Those with positive S-IgG were further from transplant, had lower mycophenolate doses, more likely to have had COVID infection pre-vaccination, and had lower rates of hypogammaglobulinemia. Only 3 patients (5.5%) developed dnDSA after vaccination; all were S-IgG positive. One had history of antibody mediated rejection (AMR), while another was initially negative for dnDSA at 6 weeks post-vaccination, but turned positive at 7 months (low level Class II DSA). One patient who had prior DSA developed clinical rejection (AMR) with Class II dnDSA (DR7) and significant rise in prior DSA (DR53, DQ2) to >20,000 MFI at 6 months (negative at 3 months) post-vaccine in the setting of new viral infection. Another patient was excluded from this study as he died of AMR and dnClass II DSA (DQ8 > 10,000 MFI, DQ6, DR4 within 5 days of dose) 2 months after his first Pfizer/BioNTech dose, but before 3 month S-IgG testing. Conclusion In our cohort, dnDSA after SARS-CoV-2 vaccination was uncommon but observed in patients who developed S-IgG response. The single AMR case occurred late and may be related to infection. In the excluded patient with acute AMR early after vaccine, correlation to S-IgG is unknown as the patient did not survive to 3 months. Further studies are needed to determine the impact of additional vaccine doses and long-term outcomes and immune responses.

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An Interactive Tool to Forecast US Hospital Needs in the Coronavirus 2019 Pandemic

Hospital enterprises are currently faced with anticipating the spread of COVID-19 and the effects it will have on visits, admissions, bed needs, and crucial supplies. While many studies have focused on understanding the basic epidemiology of the disease, few open source tools have been made available to aid hospitals in their planning. We developed a web-based application for US states and territories that allows users to choose from a suite of models already employed in characterizing the spread of COVID-19. Users can obtain forecasts for hospital visits and admissions as well as anticipated needs for ICU and non-ICU beds, ventilators, and personal protective equipment supplies. Users can also customize a large set of inputs, view the variability in forecasts over time, and download forecast data. We describe our web application and its models in detail and provide recommendations and caveats for its use. Our application is primarily designed for hospital leaders, healthcare workers, and government official who may lack specialized knowledge in epidemiology and modeling. However, specialists can also use our open source code as a platform for modification and deeper study. As the dynamics of COVID-19 within the US change, our application will also change to meet emerging needs and questions of the healthcare community.

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Spatial Distribution of Air Pollution, Hotspots and Sources in an Urban-Industrial Area in the Lisbon Metropolitan Area, Portugal—A Biomonitoring Approach

This study aimed to understand the influence of industries (including steelworks, lime factories, and industry of metal waste management and treatment) on the air quality of the urban-industrial area of Seixal (Portugal), where the local population has often expressed concerns regarding the air quality. The adopted strategy was based on biomonitoring of air pollution using transplanted lichens distributed over a grid to cover the study area. Moreover, the study was conducted during the first period of national lockdown due to COVID-19, whereas local industries kept their normal working schedule. Using a set of different statistical analysis approaches (such as enrichment and contamination factors, Spearman correlations, and evaluation of spatial patterns) to the chemical content of the exposed transplanted lichens, it was possible to assess hotspots of air pollution and to identify five sources affecting the local air quality: (i) a soil source of natural origin (based on Al, Si, and Ti), (ii) a soil source of natural and anthropogenic origins (based on Fe and Mg), (iii) a source from the local industrial activity, namely steelworks (based on Co, Cr, Mn, Pb, and Zn); (iv) a source from the road traffic (based on Cr, Cu, and Zn), and (v) a source of biomass burning (based on Br and K). The impact of the industries located in the study area on the local air quality was identified (namely, the steelworks), confirming the concerns of the local population. This valuable information is essential to improve future planning and optimize the assessment of particulate matter levels by reference methods, which will allow a quantitative analysis of the issue, based on national and European legislation, and to define the quantitative contribution of pollution sources and to design target mitigation measures to improve local air quality.

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Impact of COVID-19 on travel behaviour, transport, lifestyles and location choices in Scotland

In March 2020, the UK and Scottish Governments imposed a lockdown restricting everyday life activities to only the most essential. These Governmental measures together with individual choices to refrain from travelling during the COVID-19 pandemic have had a profound effect on transport related activity. In the current investigation an online questionnaire was distributed to 994 Scottish residents in order to identify travel habits, attitudes and preferences during the different phases of the COVID-19 pandemic outbreak and anticipated travel habits after the pandemic. Quota constraints were enforced for age, gender and household income to ensure the sample was representative of the Scottish population as a whole. Perceptions of risk, trust in information sources and compliance with COVID-19 regulations were determined together with changes in levels of life satisfaction and modal choice following the onset of COVID-19. In addition, survey responses were used to identify anticipated travel mode use in the future. Consideration was also given to the effects of COVID-19 on transport related lifestyle issues such as working from home, online shopping and the expectations of moving residences in the future. As part of the analysis, statistical models were developed to provide an insight into both the relationships between the levels of non compliance with COVID-19 regulations and demographic variables and the respondent attributes which might affect future public transport usage. In general, the study confirmed significant reductions in traffic activity, among respondents during the COVID-19 pandemic associated with walking, driving a car and either using a bus or train. The respondents also indicated that they anticipated they would continue to make less use of buses and trains at the end of the pandemic.

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Covid-19 and headache characteristics

Background & Objective: Studies have shown that the most common neurologic symptom in patients with COVID-19 is headache, which may even be the first and only symptom. This study aimed to determine headache characteristics such as frequency, duration and localization, as well as the relationship of systemic inflammation with headaches in patients with COVID-19. Methods: A total of 202 patients hospitalized for COVID-19, consisting of 101 patients with headaches and 101 patients with no headache, were included in the study. Demographic characteristics, symptoms, clinical findings, and laboratory results were evaluated. In the group with headaches, visual analog scale (VAS) scores, duration, severity, and localization of pain were recorded. Results: One hundred nineteen (58.9%) of the patients had no headache in their previous medical history, whereas 21.3% (43/202) had a migraine history. Most of the patients with headache experienced short-term attacks of moderate-severity headaches (47.1%) that were pressing in nature (59%), and generalized (32.4%). We divided our patients into two groups according to pain severity: one of patients with mild-to-moderate headache and one of those with severe headache.. Pain characteristics were compared between the groups, and it was observed that the pain duration was longer in the group with severe pain (p<0.001). When the groups with and without headaches were compared, no significant differences were found between the groups regarding inflammatory markers such as lymphocyte count, lactate dehydrogenase, C-reactive protein, ferritin, and D-dimer levels. Conclusion: The headache in our patients with COVID-19 was mostly new-onset, of moderate severity, compressive in nature, and generalized. Inflammatory markers were unrelated to the presence and severity of the headaches. [ABSTRACT FROM AUTHOR] Copyright of Neurology Asia is the property of Association of South East Asian Nations, Neurological Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Implementing the 2020–2025 Dietary Guidelines for Americans: Recommendations for a Path Forward

The Dietary Guidelines for Americans (DGA) provide science-based recommendations for healthy dietary patterns to promote health and reduce risk of chronic diseases. Yet, since their inception in 1980 and updates every 5 y, Americans fall short of meeting dietary recommendations and diet-related chronic diseases continue to be a public health concern. In May of 2021, the Institute of Food Technologists and the Department of Food Science at the University of Massachusetts, Amherst, convened a diverse group of thought leaders in health, nutrition, and food science to identify opportunities and approaches to improve consumer adoption of the DGA recommendations. The invited leaders collaborated in roundtable discussions to develop recommendations and strategies to promote adoption of the DGA recommendations after hearing sessions on the latest consumer trends, advances in food science and technology, and effective communications approaches. Participants agreed that changes in consumer behaviors and heightened interest in health due to the novel coronavirus pandemic have created an opportune time to engage consumers about healthy eating. Communications must be simple, tailored to the consumer, and delivered by influencer(s)/spokesperson(s) who are credible sources and share personal values. Innovations in food science and technology have enabled improvements in the safety, health, acceptability, affordability, and availability of foods, but opportunities to provide more options to enhance consumption of desired food groups, such as fruits, vegetables, and whole grains, remain. Moving Americans toward healthier dietary patterns aligned with DGA recommendations will require collaborations within the food sector and beyond to achieve broad-scale amplification and investment. Thought leaders in health, nutrition, and food science identified opportunities to improve consumer adoption of the Dietary Guidelines for Americans 2020–2025 through better communication, collaboration, and innovation.

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Conduct of Virtual Neurology DM Final Examination during COVID-19 Pandemic

Medical training programs are witnessing immense disruptions worldwide due to the ongoing COVID-19 pandemic. Keeping in mind the trainees' future prospects, it is important to provide continuity of teaching and timely certification assessments. Overcoming the obstacles to routine functioning presented by SARS-CoV-2 spread, we recently conducted the DM Neurology exit examination in a hybrid virtual format. We created a curated case repository with history and clinical examination findings followed by structured questions that could be built upon for case discussions. The external examiners assessed the candidates virtually through a video conferencing platform. The end results were well accepted by all key stake holders. The concerns, logistics and experience of conducting the DM Neurology exit exam in a virtual format are summarized here.

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DeepGOWeb: fast and accurate protein function prediction on the (Semantic) Web

Understanding the functions of proteins is crucial to understand biological processes on a molecular level. Many more protein sequences are available than can be investigated experimentally. DeepGOPlus is a protein function prediction method based on deep learning and sequence similarity. DeepGOWeb makes the prediction model available through a website, an API, and through the SPARQL query language for interoperability with databases that rely on Semantic Web technologies. DeepGOWeb provides accurate and fast predictions and ensures that predicted functions are consistent with the Gene Ontology; it can provide predictions for any protein and any function in Gene Ontology. DeepGOWeb is freely available at https://deepgo.cbrc.kaust.edu.sa/.

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Identification of risk factors contributing to COVID-19 incidence rates in Bangladesh: A GIS-based spatial modeling approach

Background COVID-19 pandemic outbreak is an unprecedented shock throughout the world, which has generated a massive social, human, and economic crisis Identification of risk factors is crucial to prevent the COVID-19 spread by taking appropriate countermeasures effectively Therefore, this study aimed to identify the potential risk factors contributing to the COVID-19 incidence rates at the district-level in Bangladesh Method ology: Spatial regression methods were applied in this study to fulfill the aim Data related to 28 demographic, economic, built environment, health, and facilities related factors were collected from secondary sources and analyzed to explain the spatial variability of this disease incidence Three global (ordinary least squares (OLS), spatial lag model (SLM), and spatial error model (SEM)) and one local (geographically weighted regression (GWR)) regression models were developed in this study Results The results of the models identified four factors: percentage of the urban population, monthly consumption, number of health workers, and distance from the capital city, as significant risk factors affecting the COVID-19 incidence rates in Bangladesh Among the four developed models, the GWR model performed the best in explaining the variation of COVID-19 incidence rates across Bangladesh with an R2 value of 78 6% Conclusion Findings and discussions from this research offer a better insight into the COVID-19 situation, which helped discuss policy implications to negotiate the future epidemic crisis The primary policy response would be to decentralize the urban population and economic activities from and around the capital city, Dhaka to create self-sufficient regions throughout the country, especially in the north-western region

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Preparing for the next wave of COVID-19: resilience in the face of a spreading pandemic

COVID-19 painfully demonstrates how little resilience our societies have to novel viruses. Societies, decision makers, and scientists lack (1) a comprehensive understanding of the complexity of viral outbreaks and their impact on society;(2) intervention portfolios;and (3) a global crisis and resilience policy, all of which are required to develop appropriate measures and to improve societal resilience. We highlight COVID-19 immunity as one key benchmark in preparation for the next wave of the pandemic. Specifically, using network scenarios, we demonstrate the substantial advantage of reintegrating health care workers with acquired COVID-19 immunity in epidemic hotspots, which would not only enable their safe contribution to the health care system but also drastically contain further spread.

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E-Poster abstract Pattern of serum lithium levels in consecutive samples over a five year period at a tertiary care centre in India

BACKGROUND: In spite of prevalent use of lithium therapy in clinical settings, there is not much published literature on lithium levels in Indian patient samples AIM: The study aimed to describe the pattern and trend of serum lithium level in consecutive serum lithium estimations between January 2015 and December 2019. It did not include 2020-2021 due to frequent COVID-19 related service disruptions in this period. METHODS: This was a retrospective review of lithium laboratory records for consecutive samples received over a five year period at Department of Psychiatry, AIIMS, New Delhi. RESULTS: A total of 4,376 samples were received over five year period (mean age: 34.98±13.06 years; 62% males; out-patient: 87.4%). One-third (36.3%) samples had serum lithium levels <0.60 mEq/L and a small percentage (3.6%) were in toxic range. Further analysis was restricted to out-patient samples within therapeutic range (0.6-1.2 mEq/L) (N=2,278). One-way between-groups ANOVA (Feb-April, May-July, Aug-Oct, Nov-Jan) was significant (F=3.021; df=3; p=0.029), with LSD post-hoc showing a small but statistically significant difference in mean lithium levels of Aug-Oct compared to Nov-Jan (p=0.007) and Feb-April (p=0.015). Further, serum lithium level was positively correlated to age (p=0.019), serum potassium (p=0.002), and inversely correlated to serum sodium (p<0.001). CONCLUSION: Those with older age and lower sodium levels appear to have higher lithium levels, concordant with existing literature. Serum lithium levels showed a slight but significant elevation in Aug-Oct compared to Nov-Jan and Feb-April. This finding can be explored further with respect to weather variables including temperature and humidity for same period.

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Cough Sound Classification Based on Similarity Metrics

Cough and respiratory sound processing can assist in the early diagnosis of infections such as Covid-19. Even asymptomatic Covid-19 patients can be diagnosed early enough if appropriate speech modeling and signal-processing is applied. Covid-19 affects various speech subsystems that are involved in respiration, phonation and articulation. Based on a symptom tracking platform that was recently presented by the authors (Coronario), we focus on the sound processing subsystem that is capable of classifying cough or respiratory sounds in multiple categories. Specifically, we attempt to classify a cough sound file in one of the following 5 categories: male dry or productive, female dry or productive and child's cough. The classification is performed using Pearson Correlation Similarity, in frequency domain. Several alternative methods that employ averaging and Principal Component Analysis have been tested to estimate their recall and precision/accuracy metrics. The average precision/accuracy achieved is about 75% and 88%, respectively. The sound processing platform used is extensible allowing researches to experiment with several different classification methods applied on the anonymized data exchanged during symptom tracking. © 2021 IEEE.

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Evidence of disorientation towards immunization on online social media after contrasting political communication on vaccines. Results from an analysis of Twitter data in Italy

BACKGROUND: In Italy, in recent years, vaccination coverage for key immunizations as MMR has been declining to worryingly low levels, with large measles outbreaks. As a response in 2017, the Italian government expanded the number of mandatory immunizations introducing penalties to unvaccinated children’s families. During the 2018 general elections campaign, immunization policy entered the political debate with the government in-charge blaming oppositions for fuelling vaccine scepticism. A new government (formerly in the opposition) established in 2018 temporarily relaxed penalties and announced the introduction of forms of flexibility. OBJECTIVES AND METHODS: First, we supplied a definition of disorientation, as the “lack of well-established and resilient opinions among individuals, therefore causing them to change their positions as a consequence of sufficient external perturbations”. Second, procedures for testing for the presence of both short and longer-term collective disorientation in Twitter signals were proposed. Third, a sentiment analysis on tweets posted in Italian during 2018 on immunization topics, and related polarity evaluations, were used to investigate whether the contrasting announcements at the highest political level might have originated disorientation amongst the Italian public. RESULTS: Vaccine-relevant tweeters’ interactions peaked in response to main political events. Out of retained tweets, 70.0% resulted favourable to vaccination, 16.4% unfavourable, and 13.6% undecided, respectively. The smoothed time series of polarity proportions exhibit frequent large changes in the favourable proportion, superimposed to a clear up-and-down trend synchronized with the switch between governments in Spring 2018, suggesting evidence of disorientation among the public. CONCLUSIONS: The reported evidence of disorientation for opinions expressed in online social media shows that critical health topics, such as vaccination, should never be used to achieve political consensus. This is worsened by the lack of a strong Italian institutional presence on Twitter, calling for efforts to contrast misinformation and the ensuing spread of hesitancy. It remains to be seen how this disorientation will impact future parents’ vaccination decisions.

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The Digital Abutment Check: An Improvement of the Fully Digital Workflow

By using modern digitalization techniques, an existing denture can be digitized and aid the provision of a new implant-supported denture according to a fully digital workflow. This includes fully navigated implant surgery and results in an immediately provided prosthetic restoration. However, even with the current digital workflow, it is challenging to achieve a definitive prosthetic restoration in a single treatment session. In order to achieve a definitive denture in as few treatment sessions as possible, we have implemented the digital abutment test. This test modified the existing data set and determined the final restoration. In the present case, the preexisting maxillary removable complete denture was converted into a fixed immediate restoration using the fully digital workflow. The workflow is divided into two treatment phases, each with three treatment sessions, where part of the second phase involves an innovative digital abutment check. The illustrated case shows an effective use of current digital possibilities. Special attention was also paid to a minimally invasive course of therapy.

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Functional groups of entomofauna associated to aquatic macrophytes in Correntoso river, Rio Negro sub-region, Pantanal, Mato Grosso do Sul State, Brazil - doi: 10.4025/actascibiolsci.v34i1.7822

This work aimed to study the structure of functional groups of entomofauna associated to aquatic macrophytes in Correntoso river, Rio Negro sub-region, Pantanal, Mato Grosso do Sul State, Brazil. Six samples were taken in different seasonal periods; ebb, dry and wet. The organisms were collected using D net (300 m mesh), sweeping five times through the roots of macrophyte banks at each sample session. Three environments were compared (open, intermediary, close) using data from six collection sites, through which were analyzed absolute abundance, observed richness of families and the sampled specimens were also separated in functional groups. A total of 60 families from 12 orders of Insecta were registered, totaling 19,773 sampled insects. The largest number of families was categorized into predators functional group, with 34 families collected, followed by the collectors with 17, shredders-herbivores ten and scrapers eight.

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Les séquelles de virose en pneumopédiatrie

Résumé L’immaturité du système immunitaire explique une part de la vulnérabilité aux pathogènes respiratoires durant l’enfance. Une infection virale respiratoire aiguë chez l’enfant peut être secondaire à 1 des 200 virus génétiquement différents et identifiables par les outils moléculaires. Les cellules ciliées distribuées tout au long de l’épithélium des voies respiratoires sont la cible des virus. Les études épidémiologiques rapportent une diminution de la fonction respiratoire chez l’adulte indépendamment de facteurs confondants lorsqu’une pneumonie est survenue avant l’âge de 2 voire 7 ans. Cette réduction de la fonction respiratoire est le reflet probable de l’atteinte initiale malgré les processus de réparation (altération potentielle de croissance pulmonaire) et à l’âge adulte d’une accélération du déclin physiologique des capacités ventilatoires. Les études portant sur l’origine des dilatations des bronches retrouvent des antécédents de pneumopathies infectieuses plus d’une fois sur deux. Les infections à adénovirus sont particulièrement en cause. Une bronchiolite obstructive post-infectieuse peut survenir même chez l’enfant immunocompétent ; le tableau initial est très souvent pseudo-grippal, puis est marqué par une dissociation entre des signes fonctionnels importants et un examen clinique pauvre. L’évolution au long cours est peu prévisible mais peut conduire à l’insuffisance respiratoire chronique létale. Les pneumopathies infiltratives diffuses sont caractérisées par une infiltration diffuse de la charpente conjonctivale du poumon par des cellules inflammatoires et de la fibrose. Le rôle des virus dans son développement a été évoqué en raison de la présence d’inclusions cellulaires évoquant des particules virales dans le poumon d’enfants atteints. Enfin la plupart des études épidémiologiques soulignent l’association entre une symptomatologie sifflante secondaire à une agression virale durant l’enfance et le risque ultérieur de développement d’un asthme. Summary Community-acquired viral bronchopneumonia is frequent, particularly in children, and can be associated with all types of respiratory viruses. Immature immunity explains the vulnerability to respiratory pathogens during childhood. Epithelial cells distributed throughout the airway epithelium are the target of viruses. Epidemiological studies report a decrease in respiratory function in adults, regardless of confounding factors, who had pneumonia before the age of 2 or even 7years. This reduction in respiratory function is a consequence of the initial involvement and of the accelerated physiological decline in adulthood. Studies on the origin of bronchial dilatation have found a history of infectious pneumonia in more than 50% of cases. Adenoviral infections in particular are involved. Postinfectious obstructive bronchiolitis can occur even in immunocompetent children. The initial clinical picture is often flu-like, and is subsequently marked by a dissociation between important functional signs and a poor clinical presentation. The long-term course is not predictable but can lead to lethal chronic respiratory failure. Diffuse infiltrative pneumonitis is characterized by pulmonary diffuse infiltration with inflammatory cells and fibrosis. The role of viruses in its development has been mentioned due to the presence of cellular inclusions evoking viral particles in the lungs of affected children. Finally, most epidemiological studies emphasize the association between wheezing symptoms secondary to viral infection in childhood and the subsequent risk of developing asthma.

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Mechanistic insight on the remdesivir binding to RNA-Dependent RNA polymerase (RdRp) of SARS-cov-2

The RNA-dependent RNA polymerase (RdRp) is a key enzyme which regulates the viral replication of SARS-CoV-2. Remdesivir (RDV) is clinically used drug which targets RdRp, however its mechanism of action remains elusive. This study aims to find out the binding dynamics of active Remdesivir-triphosphate (RDV-TP) to RdRp by means of molecular dynamics (MD) simulation. We built a homology model of RdRp along with RNA and manganese ion using RdRp hepatitis C virus and recent SARS-CoV-2 structures. We determined that the model was stable during the 500 ns MD simulations. We then employed the model to study the binding of RDV-TP to RdRp during three independent 500 ns MD simulations. It was revealed that the interactions of protein and template-primer RNA were dominated by salt bridge interactions with phosphate groups of RNA, while interactions with base pairs of template-primer RNA were minimal. The binding of RDV-TP showed that the position of phosphate groups was at the entry of the NTP channel and it was stabilized by the interactions with K551, R553, and K621, while the adenosine group on RDV-TP was pairing with U2 of the template strand. The manganese ion was located close to D618, D760, and D761, and helps in stabilization of the phosphate groups of RDV-TP. Further we identified three hits from the natural product database that pose similar to RDV-TP while having lower binding energies than that of RDV-TP, and that SN00359915 had binding free energy about three times lower than that of RDV-TP.

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Temporal dynamics of the host molecular responses underlying severe COVID-19 progression and disease resolution

BACKGROUND: The coronavirus disease-19 (COVID-19) pandemic has cost lives and economic hardships globally. Various studies have found a number of different factors, such as hyperinflammation and exhausted/suppressed T cell responses to the etiological SARS coronavirus-2 (SARS-CoV-2), being associated with severe COVID-19. However, sieving the causative from associative factors of respiratory dysfunction has remained rudimentary. METHODS: We postulated that the host responses causative of respiratory dysfunction would track most closely with disease progression and resolution and thus be differentiated from other factors that are statistically associated with but not causative of severe COVID-19. To track the temporal dynamics of the host responses involved, we examined the changes in gene expression in whole blood of 6 severe and 4 non-severe COVID-19 patients across 15 different timepoints spanning the nadir of respiratory function. FINDINGS: We found that neutrophil activation but not type I interferon signaling transcripts tracked most closely with disease progression and resolution. Moreover, transcripts encoding for protein phosphorylation, particularly the serine-threonine kinases, many of which have known T cell proliferation and activation functions, were increased after and may thus contribute to the upswing of respiratory function. Notably, these associative genes were targeted by dexamethasone, but not methylprednisolone, which is consistent with efficacy outcomes in clinical trials. INTERPRETATION: Our findings suggest neutrophil activation as a critical factor of respiratory dysfunction in COVID-19. Drugs that target this pathway could be potentially repurposed for the treatment of severe COVID-19. FUNDING: This study was sponsored in part by a generous gift from The Hour Glass. EEO and JGL are funded by the National Medical Research Council of Singapore, through the Clinician Scientist Awards awarded by the National Research Foundation of Singapore.

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Insight into PCR testing for surgeons

The most commonly used molecular diagnostic technique is the polymerase chain reaction (PCR). PCR detects a short section of genetic code of interest, a cancer gene, human mRNA or a pathogen's genome. It is used by every specialty in medicine and surgery, with increasing frequency and importance. In this article, the history, steps of the cycle, uses, forms, advantages and disadvantages of PCR are discussed. With the SARS coronavirus-2 pandemic having such an enormous impact on the delivery of elective surgery, decisions to proceed or defer are made by surgeons on a daily basis, based on PCR results. An understanding of these results is provided, what they tell us, what they do not and what other information is required to make these decisions. It is imperative to also look beyond PCR results, seeing the patient within the context of their symptoms, other pathology and imaging results, with the assistance of a medical virologist or microbiologist, in complex cases.

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A systematic review and meta-analysis to evaluate the clinical outcomes in COVID-19 patients on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers

INTRODUCTION: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) share their target receptor site with the SARS-CoV-2 virus, that may cause ACE2 receptor up-regulation which raised concerns regarding ACEI and ARB use in COVID-19 patients. However, many medical professional societies recommended their continued use given the paucity of clinical evidence, but there is a need for an updated systematic review and meta-analysis of the latest clinical studies. METHODS AND RESULTS: A search was conducted on PubMed, Google Scholar, EMBASE, and various preprint servers for studies comparing clinical outcomes and mortality in COVID-19 patients on ACEIs and/or ARBs, and a meta-analysis was performed. A total of 16 studies were included for the review and meta-analysis. There were conflicting findings reported in the rates of severity and mortality in several studies. In a pooled analysis of four studies, there was a statistically non-significant association of ACEI/ARB use with lower odds of developing severe disease vs. non-users [odds ratio (OR) = 0.81, 95% confidence interval (CI): 0.41–1.58, I(2)=50.52, P-value = 0.53). In a pooled analysis of six studies, there was a statistically non-significant association of ACEI/ARB use with lower odds of mortality as compared with non-users (OR = 0.86, 95% CI = 0.53–1.41, I(2) = 79.12, P-value = 0.55). CONCLUSION: It is concluded that ACEIs and ARBs should be continued in COVID-19 patients, reinforcing the recommendations made by several medical societies. Additionally, the individual patient factors such as ACE2 polymorphisms which might confer higher risk of adverse outcomes need to be evaluated further.

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Diagnostic role of chest computed tomography in coronavirus disease 2019

Coronavirus disease 2019 (COVID­19) is an infectious disease caused by a novel strain of coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2), that appeared in China in December 2019 and spread globally, evolving into the currently observed pandemic. The laboratory diagnosis of SARS­CoV­2 infection is currently based on real­time reverse transcriptase-polymerase chain reaction (RT­PCR) testing, and imaging cannot replace genetic testing in patients with suspected COVID­19. However, with predominant respiratory manifestations of COVID­19, particularly in more severe cases, chest imaging using computed tomography (CT) plays a major role in detecting viral lung infection, evaluating the nature and extent of pulmonary lesions, and monitoring the disease activity. The role of chest CT as a diagnostic tool may be increased when the laboratory testing capacities using RT­PCR prove inaccurate or insufficient during a major outbreak of the disease. In these settings, a rapid presumptive diagnosis of COVID­19 potentially offered by CT might be an advantage, in addition to obvious benefits of delineating the nature and extent of pulmonary lesions. In the present paper, we reviewed the diagnostic role of chest CT in patients with COVID­19.

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Prediction of Left Double-Lumen Tube Size by Measurement of Cricoid Cartilage Transverse Diameter by Ultrasound and CT Multi-Planar Reconstruction

Background: Currently, there is no uniform standard for selecting the left double lumen tubes (LDLT). Advantages, such as safety and convenience of the ultrasonic technology, and measurement accuracy, make it more widely applied in the clinical anesthesia, and computed tomography (CT) multi-planar reconstruction (MPR) technology will certainly provide a more accurate measurement. For better application for thoracic surgery choice LDLT, relieving the injury to patients, and reducing the complications, this study will compare the two approaches. Methods: The first part, 120 cases of patients were selected according to the height and gender; recording the patient's optimum LDLT and measurement the transverse diameter of the cricoid cartilage (TD-C) by ultrasound and CT MPR, and then obtained the TD-C range measurement by ultrasound and CT MPR corresponding to different types of LDLT. The second part, total of 102 patients were divided into the ultrasound group and the CT MPR group. In the ultrasound group, TD-C was measured by ultrasound, the corresponding size for intubation was selected based on the conclusions derived from the first part. In the CT MPR group, TD-C was measured by CT MPR, the corresponding size of LDLT based on the conclusions derived from the first part. Results: In the first part, 120 patients were no significant difference in the basic characteristics (P > 0.05). The accuracy of selecting the LDLT by conventional experience, namely height and gender was 58.3%. Ultrasonic measurement TD-C range was as follows: 32 Fr <15.88, 35 Fr: 15.88–16.80, 37 Fr: 16.75–17.81, and 39 Fr > 17.80. CT MPR measurement TD-C range was as follows: 32 Fr <15.74, 35 Fr: 15.74–16.65, 37 Fr: 16.56–17.68, and 39 Fr > 17.65. In the second part, there was no significant difference in the basic characteristics between the two groups (P > 0.05). The accuracy of intubation in the ultrasound group was 90.2% and the corresponding in the CT MPR group was 94.1% (P > 0.05). Conclusions: The accuracy of selecting the LDLT based on TD-C is significantly higher than conventional experience; it can significantly reduce the post-operative complications and there was no statistical significance in the accuracy of LDLT selected for TD-C measurement by ultrasound vs. CT, and both of them could be safely used for the evaluation before intubation under anesthesia in thoracic surgery.

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Eruptive Angiomatosis Triggered by COVID-19 Vaccination

Despite meeting strict standards of quality, safety, and effectiveness, rare systemic and cutaneous side effects of coronavirus disease 2019 (COVID-19) vaccinations continue to be reported throughout the world. We report a case of eruptive cherry angiomatosis in a female following her first dose of COVID-19 vaccination with subsequent crops appearing after the second dose. The biopsy revealed dilated capillaries within the superficial dermis consistent with the clinical diagnosis.

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Effects of explicit cueing and ambiguity on the anticipation and experience of a painful thermal stimulus.

Many factors can influence the way in which we perceive painful events and noxious stimuli, but less is known about how pain perception is altered by explicit knowledge about the impending sensation. This study aimed to investigate the impact of explicit cueing on anxiety, arousal, and pain experience during the anticipation and delivery of noxious thermal heat stimulations. Fifty-two healthy volunteers were randomised to receive explicit instructions about visual cue-stimulus temperature pairings, or no explicit instructions about the cue-stimulus pairs. A pain anxiety task was used to investigate the effects of explicit cueing on anticipatory anxiety, pain experience and electrophysiological responses. Participants who received explicit instructions about the cue-stimulus pairs (i.e., the relationship between the colour of the cue and the temperature of the associated stimuli) reported significantly higher subjective anxiety prior to the delivery of the thermal heat stimuli (p = .025, partial eta squared = .10). There were no effects of explicit cueing on subsequent pain intensity, unpleasantness, or the electrophysiological response to stimulus delivery. The perceived intensity and unpleasantness of the stimuli decreased across the blocks of the paradigm. In both groups anticipating the ambiguous cue elicited the largest change in electrophysiological arousal, indicating that not knowing the impending stimulus temperature led to increased arousal, compared to being certain of receiving a high temperature thermal stimulus (both p < .001). Perceived stimulus intensity varied between ambiguous and non-ambiguous cues, depending on the temperature of the stimulus. Together these findings highlight the impact and importance of explicit cueing and uncertainty in experimental pain studies, and how these factors influence the way healthy individuals perceive and react to noxious and innocuous thermal stimuli.

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A comparative study of the sooting tendencies of various C5-C8 alkanes, alkenes and cycloalkanes in counterflow diffusion flames

In this work, sooting tendencies of various vaporized C5-C8 alkanes, alkenes, cycloalkanes were investigated in a counterflow diffusion flame (CDF) configuration. Mie scattering and laser induced incandescence (LII) were respectively employed to measure the sooting limits and soot volume fraction, both of which were used as quantitative sooting tendency indices of the flames. Research foci were paid to analyze the impacts of fuel molecular structure on sooting tendencies, ranging from the length of the carbon chain, fuel unsaturation, presence and position of the branched chain as well as the cyclic ring structure. It was found that the present CDF-based sooting tendency data did not always agree with existing literature results that were obtained from either coflow or premixed flame experiments, indicating the importance of considering flame conditions when assessing fuel sooting tendencies. Several interesting observations were made; in particular, our results showed that the sooting limits of C5-C8 n-alkane is comparable, regardless of the carbon-chain length, indicating an interesting fuel similarity pertinent to sooting tendency. In addition, we found that cyclopentane, with a five-membered ring, has even stronger sooting propensity than the six-membered cyclohexane; this trend occurs because cyclopentane prefers to decompose to more odd-carbon radicals of cyclopentadienyl and allyl, which are efficient aromatic precursors. Our results are expected to serve as necessary complements to existing sooting index data for a deeper understanding of the correlation between fuel molecular structures and their sooting tendencies.

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Collecting Pandemic Phenomena: Reflections on Rapid Response Collecting and the Art Museum

Rapid Response Collecting has been a most apt methodology with which to document the COVID-19 pandemic for an increasing number of museums. As the phenomenon unfolded across the globe, museums searched for and head-hunted the truth-revealing objects that could tell the stories and histories of the present to current and future generations. Indeed, the COVID-19 pandemic took Rapid Response Collecting to a higher level. A methodology originally conceived for a sporadic phenomenon happening within a specific context during the early years of the 21st century gained much more traction almost overnight. This paper shall make a case for a better understanding of the potential use and application of Rapid Response Collecting by art museums. It shall look into the defining values of this collections development methodology and how these can be applied and adopted when acquiring works of art. In doing so, it shall seek to understand to what extent the mainstream version of Rapid Response Collecting can be adapted for the needs, purposes and requirements of the art museum.

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Decreased utilization of mental health emergency service during the COVID-19 pandemic

During the rapid rise of the COVID-19 pandemic, a reduction of the numbers of patients presenting to emergency departments has been observed. We present an early study from a German psychiatric hospital to assess the dynamics of mental health emergency service utilization rates during the COVID-19 pandemic. Our results show that the numbers of emergency presentations decreased, and a positive correlation between these numbers and mobility of the general public suggests an impact of extended measures of social distancing. This finding underscores the necessity of raising and sustaining awareness regarding the threat to mental health in the context of the pandemic.

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Small-molecule ligands can inhibit −1 programmed ribosomal frameshifting in a broad spectrum of coronaviruses

Recurrent outbreaks of novel zoonotic coronavirus (CoV) diseases since 2000 have high-lighted the importance of developing therapeutics with broad-spectrum activity against CoVs. Because all CoVs use −1 programmed ribosomal frameshifting (−1 PRF) to control expression of key viral proteins, the frameshift signal in viral mRNA that stimulates −1 PRF provides a promising potential target for such therapeutics. To test the viability of this strategy, we explored a group of 6 small-molecule ligands, evaluating their activity against the frameshift signals from a panel of representative bat CoVs—the most likely source of future zoonoses—as well as SARS-CoV-2 and MERS-CoV. We found that whereas some ligands had notable activity against only a few of the frameshift signals, the serine protease inhibitor nafamostat suppressed −1 PRF significantly in several of them, while having limited to no effect on −1 PRF caused by frameshift signals from other viruses used as negative controls. These results suggest it is possible to find small-molecule ligands that inhibit −1 PRF specifically in a broad spectrum of CoVs, establishing the frameshift signal as a viable target for developing pan-coronaviral therapeutics.

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How Patient Organizations Can Drive FAIR Data Efforts to Facilitate Research and Health Care: A Report of the Virtual Second International Meeting on Duchenne Data Sharing, March 3, 2021

BACKGROUND: For patients with rare diseases such as Duchenne and Becker muscular dystrophy (DMD/BMD), access to their health data is key to being able to advocate for themselves and be in control of their care. Since 2018, the DMD/BMD patient community has been committed to making DMD/BMD-related data FAIR, i.e., Findable, Accessible, Interoperable, and Reusable. On March 3, 2021, the second international meeting on FAIR data sharing for DMD/BMD was held virtually. OBJECTIVE: The aim of this meeting report is to summarize the presentations and discussions of the meeting. METHODS: During this meeting, the progress of FAIRification efforts since the first international meeting in 2019, new developments, stakeholder perspectives, and experiences from implementing FAIR data principles in practice were presented and discussed. RESULTS: Over 120 attendees representing various stakeholder groups (ie, patient organizations, clinicians, clinical and academic researchers, pharmaceutical companies, regulators, and EU organizations) from 22 countries participated in the meeting. This meeting report summarizes the presentations and discussions from the meeting, provides an overview of the key lessons learned since the first meeting, and outlines the next steps. CONCLUSIONS: Patient organizations are key drivers of the FAIRification process in practice and dialogue with stakeholders is critical to success.

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Outside In: Chorus and clearing in the time of pandemic and protest

A sonic ensemble, this essay describes how the COVID-19 pandemic cleared the way for heightened protest against racial violence Both the pandemic and Black Lives Matter address the acoustical threshold between the inside and outside, being a call to listen rather than simply to hear Arguing that the call exceeds the confines of the first-person subject, particularly in its chants for justice, the essay moves through auditory fragments of pandemic and protest These fragments are connected through the fact of air, breathe, and the recognition of a shared world and its chorus Copyright © 2020 Julie Beth Napolin

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E-shops evaluation during COVID-19 lockdown using E-S-qual and AHP-topsis

This paper uses the E-S-QUAL model, analytic hierarchy process (AHP), and technique for order performance by similarity to ideal solution (TOPSIS) to evaluate e-commerce B2C websites among coffee-chain leaders in the Greek market. The research took place during the lockdown in Greece, due to COVID-19, which increased online sales. Our findings suggest that system availability and fulfillment are the two most important dimensions of the model, while credit card information protection and webpages that do not freeze during the ordering process are considered as the most crucial sub-dimensions. Our proposed 12-step approach can help web developers focus on the most important factors when designing e-shops, while companies can lead their efforts in improving service quality when offering their products and services to online customers.Moreover, the results of the evaluation process highlight the coffee-chain e-shop that could serve as a benchmark for best practices in online service quality. © 14th IADIS International Conf. Infor. Sys. 2021. All rights reserved.

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What is the probability that a vaccinated person is shielded from Covid-19? A Bayesian MCMC based reanalysis of published data with emphasis on what should be reported as 'efficacy'

Based on the information communicated in press releases, and finally published towards the end of 2020 by Pfizer, Moderna and AstraZeneca, we have built up a simple Bayesian model, in which the main quantity of interest plays the role of {\em vaccine efficacy} (`$ε$'). The resulting Bayesian Network is processed by a Markov Chain Monte Carlo (MCMC), implemented in JAGS interfaced to R via rjags. As outcome, we get several probability density functions (pdf's) of $ε$, each conditioned on the data provided by the three pharma companies. The result is rather stable against large variations of the number of people participating in the trials and it is `somehow' in good agreement with the results provided by the companies, in the sense that their values correspond to the most probable value (`mode') of the pdf's resulting from MCMC, thus reassuring us about the validity of our simple model. However we maintain that the number to be reported as `vaccine efficacy' should be the mean of the distribution, rather than the mode, as it was already very clear to Laplace about 250 years ago (its `rule of succession' follows from the simplest problem of the kind). This is particularly important in the case in which the number of successes equals the numbers of trials, as it happens with the efficacy against `severe forms' of infection, claimed by Moderna to be 100%. The implication of the various uncertainties on the predicted number of vaccinated infectees is also shown, using both MCMC and approximated formulae.

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Suicidal ideation among Bangladeshi university students early during the COVID-19 pandemic: Prevalence estimates and correlates

Lockdown, social isolation, and interruption of daily life during the COVID-19 period have impacted many lives. University students are particularly vulnerable to such disruptions and may be particularly disposed to suicidal ideation, potentially creating a new public health crisis. This study aimed to assess suicidal ideation and associated factors among university students in Bangladesh during the early stages of the COVID-19 pandemic. A cross-sectional online survey was conducted using the Google form (Google survey tool) from April to May 2020. Initially, 3366 respondents voluntarily completed the survey form. Finally, 3331 surveys were included in the final analyses after removing incomplete surveys. The data ware reviewed, rechecked, and analyzed with SPSS (25.0 version) software. A total of 1979 (59.4%) males and 1352 (40.6%) females participated. Respondents were between the ages of 18 to 28 years (mean age 21.4 years [SD = 1.9]). The prevalence estimate of suicidal ideation was 12.8%. Potential risk factors included less sleep, excess sleep, cigarette smoking, past suicidal thoughts, suicide attempt history, family history of suicidality, depression, anxiety, and stress. Potential protective factors included being male, having lower SES, living in rural areas, regular physical exercise, and satisfactory study. Suicidal ideation was prevalent among Bangladeshi university students during the onset of the COVID-19 pandemic. Understanding the correlates of suicidal ideation may aid to develop targeted strategies to support students during and after the COVID-19 pandemic.

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Measuring the digital divide among people with Severe Mental Ill Health using the Essential Digital Skills framework.

Aims: Amidst the vast digitalisation of health and other services during the pandemic, people with no digital skills are at risk for digital exclusion. This risk might not abide by the end of the pandemic. This paper seeks to understand whether people with severe mental ill health (SMI) have the necessary digital skills to adapt to these changes and avoid digital exclusion. Methods: 249 adults with SMI across England completed a survey online or offline. They provided information on their digital skills based on the Essential Digital Skills (EDS) framework, sociodemographic information, and digital access. This is the first time the EDS is benchmarked in people with SMI. Results: 42.2% had no Foundation Skills and 46.2% lacked skills for daily life (lacking Foundation or Life Skills). 23.0% of those working lacked skills for professional life (lacking Foundation or Work Skills). The most commonly missing skills were handling passwords and using the device settings (Foundation Skills) and online problem solving (Skills for Life). People were interested in learning more about approximately half of the skills they did not have. People were more likely to lack Foundation Skills if they were older, not in employment, had a psychosis-spectrum disorder, or had no Internet access at home. Conclusion: A significant portion of people with SMI lacked Foundation Skills in this objective and benchmarked survey. This points to a high risk for digital exclusion and the need for focused policy and tailored health sector support, to ensure people retain access to key services and develop digital skills and confidence. To our knowledge this is the first time this has been described using the Essential Digital Skills (EDS) framework. Services, including the NHS, need to be aware and mitigate the risks.

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Has Covid-19 Put a Halt to Youth Migration? Preliminary Evidence from Poland

The Covid-19 outbreak has severely disrupted social life and economic activity, while also significantly affecting migration patterns. Specifically, interregional and international youth mobility has been influenced by factors such as, among others, health anxiety, the rise of distant learning, increasing uncertainty regarding household income, or movement restrictions introduced to limit the spread of pandemic. This paper aims to shed some light on youth out-migration patterns (predominantly student migration) from the Lubelskie Region (Poland) before and during the Covid-19 pandemic. The data were collected in five cross-sectional census surveys tracking student enrolment and subsequent mobility patterns, conducted annually, each autumn from 2016 to 2020. We present our evidence in a broader context by summarizing the course of Covid-19 pandemic in Poland and the key preventive measures taken. Our study reveals that youth out-migration during the Covid-19 pandemic saw the largest increase since the launch of the research in 2016. This unexpected change was the outcome of a moderate increase in interregional student mobility and a decrease in labour migration (both internal and international), while the rate of international student out-migration showed no significant change compared to previous years. In the discussion, we refer our evidence to the ongoing debate on Covid-19 and its impact on mobility with a view to offering potential explanations. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

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Modelling the adsorption of proteins to nanoparticles at the solid-liquid interface.

HYPOTHESIS We developed a geometrical model to determine the theoretical maximum number of proteins that can pack as a monolayer surrounding a spherical nanoparticle. We applied our new model to study the adsorption of receptor binding domain (RBD) of the SARS-CoV-2 spike protein to silica nanoparticles. Due to its abundance and extensive use in manufacturing, silica represents a reservoir where the virus can accumulate. It is therefore important to study the adsorption and the persistence of viral components on inanimate surfaces. EXPERIMENTS We used previously published datasets of nanoparticle-adsorbed proteins to validate the new model. We then used integrated experimental methods and Molecular Dynamics (MD) simulations to characterise binding of the RBD to silica nanoparticles and the effect of such binding on RBD structure. FINDINGS The new model showed excellent fit with existing datasets and, combined to new RBD-silica nanoparticles binding data, revealed a surface occupancy of 32% with respect to the maximum RBD packing theoretically achievable. Up to 25% of RBD's secondary structures undergo conformational changes as a consequence of adsorption onto silica nanoparticles. Our findings will help developing a better understanding of the principles governing interaction of proteins with surfaces and can contribute to control the spread of SARS-CoV-2 through contaminated objects.

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SARS-CoV-2 RT-PCR positivity and antibody prevalence among asymptomatic hospital-based health care workers

BACKGROUND: The level of asymptomatic infection with SARS-CoV-2 could be substantial and among health care workers (HCWs) a source of continuing transmission of the virus to patients and co-workers. OBJECTIVES: Measure the period prevalence of SARS-CoV-2 PCR positivity and seroprevalence of SARS-CoV-2 IgG antibodies among a random sample of asymptomatic health system hospital-based health care workers (HCWs) 6½ -15½ weeks after 4/5/2020, the peak of the first surge of COVID-19 admissions. RESULTS: Of 524 eligible and consented participants from four metropolitan hospitals, nasopharyngeal swabs were obtained from 439 (83.8 %) and blood from 374 (71.4 %). Using PCR nucleic acid-based amplification (NAAT) methods, the period prevalence of SARS-CoV-2 infection was 0.23 % (95 % confidence interval (CI) 0.01 %-1.28 %; 1/439) from 5/21/20-7/16/20. The seroprevalence of SARS-CoV-2 IgG antibodies from June 17-July 24, 2020 was 2.41 % (95 % CI 1.27 %-4.51 %; 9/374). Those who were reactive were younger (median age 36 versus 44 years; p = 0.050), and those with self-reported Hispanic/Latino ethnicity had a higher seroprevalence (2/12 = 16.7 % versus 7/352 = 2.0 %; p = 0.051). There were no significant differences by sex, race, residence, hospital, unit or job type. The one employee who was found to be PCR test positive in this study was also reactive for IgG antibodies, tested 27 days later. CONCLUSIONS: The period prevalence of PCR positivity to SARS-CoV-2 and IgG seroprevalence was unexpectedly low in asymptomatic HCWs after a peak in COVID-19 admissions and the establishment of state and institutional infection control policies, suggesting that routine screening tests while community prevalence is relatively low would produce a minimal yield.

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Integration of Comprehensive Metrics into the PsT1 Neuroendoscopic Training System

OBJECTIVE: Metric-based surgical training can be used to quantify the level and progression of neurosurgical performance to optimize and monitor training progress. Here we applied innovative metrics to a physical neurosurgery trainer to explore whether these metrics differentiate between different levels of experience across different tasks. METHODS: Twenty-four participants (9 experts, 15 novices) performed 4 tasks (dissection, spatial adaptation, depth adaptation, and the A-B-A task) using the PsT1 training system. Four performance metrics (collision, precision, dissected area, and time) and 6 kinematic metrics (dispersion, path length, depth perception, velocity, acceleration, and motion smoothness) were collected. RESULTS: For all tasks, the execution time (t) of the experts was significantly lower than that of novices (P < 0.05). The experts performed significantly better in all but 2 of the other metrics, dispersion and sectional area, corresponding to the A-B-A task and dissection task, respectively, for which they showed a nonsignificant trend towards better performance (P = 0.052 and P = 0.076, respectively). CONCLUSIONS: It is possible to differentiate between the skill levels of novices and experts according to parameters derived from the PsT1 platform, paving the way for the quantitative assessment of training progress using this system. During the current coronavirus disease 2019 pandemic, neurosurgical simulators that gather surgical performance metrics offer a solution to the educational needs of residents.

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Gastrointestinal and hepatic diseases during the COVID-19 pandemic: Manifestations, mechanism and management

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered the causative pathogen of coronavirus disease 2019 (COVID-19) and has become an international danger to human health. Although respiratory transmission and symptoms are still the essential manifestations of COVID-19, the digestive system could be an unconventional or supplementary route for COVID-19 to be transmitted and manifested, most likely due to the presence of angiotensin-converting enzyme 2 (ACE2) in the gastrointestinal tract. In addition, SARS-CoV-2 can trigger hepatic injury via direct binding to the ACE2 receptor in cholangiocytes, antibody-dependent enhancement of infection, systemic inflammatory response syndrome, inflammatory cytokine storms, ischemia/reperfusion injury, and adverse events of treatment drugs. Gastrointestinal symptoms, including anorexia, nausea, vomiting, and diarrhea, which are unusual in patients with COVID-19, and some digestive signs may occur without other respiratory symptoms. Furthermore, SARS-CoV-2 can be found in infected patients’ stool, demonstrating the likelihood of transmission through the fecal-oral route. In addition, liver function should be monitored during COVID-19, particularly in more severe cases. This review summarizes the evidence for extra-pulmonary manifestations, mechanisms, and management of COVID-19, particularly those related to the gastrointestinal tract and liver.

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Differentiating combined pulmonary fibrosis and emphysema from pure emphysema: utility of late gadolinium-enhanced MRI

BACKGROUND: Differentiating combined pulmonary fibrosis with emphysema (CPFE) from pure emphysema can be challenging on high-resolution computed tomography (HRCT). This has antifibrotic therapy implications. METHODS: Twenty patients with suspected CPFE underwent late gadolinium-enhanced (LGE) thoracic magnetic resonance imaging (LGE-MRI) and HRCT. Data from twelve healthy control subjects from a previous study who underwent thoracic LGE-MRI were included for comparison. Quantitative LGE signal intensity (SI) was retrospectively compared in regions of fibrosis and emphysema in CPFE patients to similar lung regions in controls. Qualitative comparisons for the presence/extent of reticulation, honeycombing, and traction bronchiectasis between LGE-MRI and HRCT were assessed by two readers in consensus. RESULTS: There were significant quantitative differences in fibrosis SI compared to emphysema SI in CPFE patients (25.8, IQR 18.4-31.0 versus 5.3, IQR 5.0-8.1, p < 0.001). Significant differences were found between LGE-MRI and HRCT in the extent of reticulation (12.5, IQR 5.0-20.0 versus 25.0, IQR 15.0-26.3, p = 0.038) and honeycombing (5.0, IQR 0.0-10.0 versus 20.0, IQR 10.6-20.0, p = 0.001) but not traction bronchiectasis (10.0, IQR 5-15 versus 15.0, IQR 5-15, p = 0.878). Receiver operator curve analysis of fibrosis SI compared to similarly located regions in control subjects showed an area under the curve of 0.82 (p = 0.002). A SI cutoff of 19 yielded a sensitivity of 75% and specificity of 86% in differentiating fibrosis from similarly located regions in control subjects. CONCLUSION: LGE-MRI can differentiate CPFE from pure emphysema and may be a useful adjunct test to HRCT in patients with suspected CPFE.

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Mathematical model of COVID-19 intervention scenarios for São Paulo-Brazil

With COVID-19 surging across the world, understanding the effectiveness of intervention strategies on transmission dynamics is of primary global health importance. Here, we develop and analyze an epidemiological compartmental model using multi-objective genetic algorithm design optimization to compare scenarios related to strategy type, the extent of social distancing, time window, and personal protection levels on the transmission dynamics of COVID-19 in São Paulo, Brazil. The results indicate that the optimal strategy for São Paulo is to reduce social distancing over time with a stepping-down reduction in the magnitude of social distancing every 80-days. Our results also indicate that the ability to reduce social distancing depends on a 5-10% increase in the current percentage of people strictly following protective guidelines, highlighting the importance of protective behavior in controlling the pandemic. Our framework can be extended to model transmission dynamics for other countries, regions, states, cities, and organizations.

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Renin-Angiotensin-Aldosterone System Blockers and the Risk of Covid-19

BACKGROUND: A potential association between the use of angiotensin-receptor blockers (ARBs) and angiotensin-converting-enzyme (ACE) inhibitors and the risk of coronavirus disease 2019 (Covid-19) has not been well studied. METHODS: We carried out a population-based case-control study in the Lombardy region of Italy. A total of 6272 case patients in whom infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed between February 21 and March 11, 2020, were matched to 30,759 beneficiaries of the Regional Health Service (controls) according to sex, age, and municipality of residence. Information about the use of selected drugs and patients' clinical profiles was obtained from regional databases of health care use. Odds ratios and 95% confidence intervals for associations between drugs and infection, with adjustment for confounders, were estimated by means of logistic regression. RESULTS: Among both case patients and controls, the mean (±SD) age was 68±13 years, and 37% were women. The use of ACE inhibitors and ARBs was more common among case patients than among controls, as was the use of other antihypertensive and non-antihypertensive drugs, and case patients had a worse clinical profile. Use of ARBs or ACE inhibitors did not show any association with Covid-19 among case patients overall (adjusted odds ratio, 0.95 [95% confidence interval {CI}, 0.86 to 1.05] for ARBs and 0.96 [95% CI, 0.87 to 1.07] for ACE inhibitors) or among patients who had a severe or fatal course of the disease (adjusted odds ratio, 0.83 [95% CI, 0.63 to 1.10] for ARBs and 0.91 [95% CI, 0.69 to 1.21] for ACE inhibitors), and no association between these variables was found according to sex. CONCLUSIONS: In this large, population-based study, the use of ACE inhibitors and ARBs was more frequent among patients with Covid-19 than among controls because of their higher prevalence of cardiovascular disease. However, there was no evidence that ACE inhibitors or ARBs affected the risk of COVID-19.

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Nursing Staff Time and Care Quality in Long-Term Care Facilities: A Systematic Review

BACKGROUND AND OBJECTIVES: In long-term care (LTC) facilities, nursing staff are important contributors to resident care and well-being. Despite this, the relationships between nursing staff coverage, care hours, and quality of resident care in LTC facilities are not well understood and have implications for policy-makers. This systematic review summarizes current evidence on the relationship between nursing staff coverage, care hours, and quality of resident care in LTC facilities. RESEARCH DESIGN AND METHODS: A structured literature search was conducted using four bibliographic databases and gray literature sources. Abstracts were screened by two independent reviewers using Covidence software. Data from the included studies were summarized using a pretested extraction form. The studies were critically appraised, and their results were synthesized narratively. RESULTS: The systematic searched yielded 15,842 citations, of which 54 studies (all observational) were included for synthesis. Most studies (n = 53, 98%) investigated the effect of nursing staff time on resident care. Eleven studies addressed minimum care hours and quality of care. One study examined the association between different nursing staff coverage models and resident outcomes. Overall, the quality of the included studies was poor. DISCUSSION AND IMPLICATIONS: Because the evidence was inconsistent and of low quality, there is uncertainty about the direction and magnitude of the association between nursing staff time and type of coverage on quality of care. More rigorously designed studies are needed to test the effects of different cutoffs of care hours and different nursing coverage models on the quality of resident care in LTC facilities.

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Recomendaciones para la limpieza y desinfección en casa (sin casos sospechosos ni confirmados), 8 de mayo de 2020

Lista de recomendaciones y elementos que deben tenerse en cuenta en la limpieza y desinfección del hogar Estas recomendaciones son aplicables únicamente cuando no haya casos sospechosos ni confirmados

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RNA of mouse hepatitis virus.

The RNA of mouse hepatitis virus, a coronavirus, was isolated from the virus released early in the infection and analyzed by sucrose gradient sedimentation and electrophoresis. It was found to consist of a piece of single-stranded RNA of about 60S. Its molecular weight was estimated to be 5.4 X 10(6) by electrophoresis in methylmercury-agarose gels. At least one third of the RNA contained polyadenylated sequences. It is, therefore, probably positive stranded. The virus harvested late in the infection contained, in addition to 60S, some 30 to 50S RNA that are possibly degradation products of the 60S RNA. No difference in the electrophoretic behavior could be detected between the RNA isolated from a pathogenic (JHM) and a nonpathogenic (A59) strain.

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Detection of Common Arrhythmias by the Watch-PAT: Expression of Electrical Arrhythmias by Pulse Recording

BACKGROUND: The WatchPAT (WP) device was shown to be accurate for the diagnosis of sleep apnea and is widely used worldwide as an ambulatory diagnostic tool. While it records peripheral arterial tone (PAT) and not electrocardiogram (ECG), the ability of it to detect arrhythmias is unknown and was not studied previously. Common arrhythmias such as atrial fibrillation (AF) or premature beats may be uniquely presented while recording PAT/pulse wave. PURPOSE: To examine the potential detection of common arrhythmias by analyzing the PAT amplitude and pulse rate/volume changes. PATIENTS AND METHODS: Patients with suspected sleep disordered breathing (SDB) were recruited with preference for patients with previously diagnosed AF or congestive heart failure (CHF). They underwent simultaneous WP and PSG studies in 11 sleep centers. A novel algorithm was developed to detect arrhythmias while measuring PAT and was tested on these patients. Manual scoring of ECG channel (recorded as part of the PSG) was blinded to the automatically analyzed WP data. RESULTS: A total of 84 patients aged 57±16 (54 males) participated in this study. Their BMI was 30±5.7Kg/m2. Of them, 41 had heart failure (49%) and 17 (20%) had AF. The sensitivity and specificity of the WP to detect AF segments (of at least 60 seconds) were 0.77 and 0.99, respectively. The correlation between the WP derived detection of premature beats (events/min) to that of the PSG one was 0.98 (p<0.001). CONCLUSION: The novel automatic algorithm of the WP can reasonably detect AF and premature beats. We suggest that when the algorithm raises a flag for arrhythmia, the patients should shortly undergo ECG and/or Holter ECG study.

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Sex and gender: modifiers of health, disease, and medicine

Clinicians can encounter sex and gender disparities in diagnostic and therapeutic responses. These disparities are noted in epidemiology, pathophysiology, clinical manifestations, disease progression, and response to treatment. This Review discusses the fundamental influences of sex and gender as modifiers of the major causes of death and morbidity. We articulate how the genetic, epigenetic, and hormonal influences of biological sex influence physiology and disease, and how the social constructs of gender affect the behaviour of the community, clinicians, and patients in the health-care system and interact with pathobiology. We aim to guide clinicians and researchers to consider sex and gender in their approach to diagnosis, prevention, and treatment of diseases as a necessary and fundamental step towards precision medicine, which will benefit men's and women's health.

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Serological Approaches for COVID-19: Epidemiologic Perspective on Surveillance and Control

Since December 2019, the novel coronavirus, SARS-CoV-2, has garnered global attention due to its rapid transmission, which has infected more than two million people worldwide. Early detection of SARS-CoV-2 is one of the crucial interventions to control virus spread and dissemination. Molecular assays have been the gold standard to directly detect for the presence of viral genetic material in infected individuals. However, insufficient viral RNA at the point of detection may lead to false negative results. As such, it is important to also employ immune-based assays to determine one's exposure to SARS-CoV-2, as well as to assist in the surveillance of individuals with prior exposure to SARS-CoV-2. Within a span of 4 months, extensive studies have been done to develop serological systems to characterize the antibody profiles, as well as to identify and generate potentially neutralizing antibodies during SARS-CoV-2 infection. The vast diversity of novel findings has added value to coronavirus research, and a strategic consolidation is crucial to encompass the latest advances and developments. This review aims to provide a concise yet extensive collation of current immunoassays for SARS-CoV-2, while discussing the strengths, limitations and applications of antibody detection in SARS-CoV-2 research and control.

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Simple rapid in vitro screening method for SARS-CoV-2 anti-virals that identifies potential cytomorbidity-associated false positives

BACKGROUND: The international SARS-CoV-2 pandemic has resulted in an urgent need to identify new anti-viral drugs for treatment of COVID-19. The initial step to identifying potential candidates usually involves in vitro screening that includes standard cytotoxicity controls. Under-appreciated is that viable, but stressed or otherwise compromised cells, can also have a reduced capacity to replicate virus. A refinement proposed herein for in vitro drug screening thus includes a simple growth assay to identify drug concentrations that cause cellular stress or “cytomorbidity”, as distinct from cytotoxicity or loss of viability. METHODS: A simple rapid bioassay is presented for antiviral drug screening using Vero E6 cells and inhibition of SARS-CoV-2 induced cytopathic effects (CPE) measured using crystal violet staining. We use high cell density for cytotoxicity assays, and low cell density for cytomorbidity assays. RESULTS: The assay clearly illustrated the anti-viral activity of remdesivir, a drug known to inhibit SARS-CoV-2 replication. In contrast, nitazoxanide, oleuropein, cyclosporine A and ribavirin all showed no ability to inhibit SARS-CoV-2 CPE. Hydroxychloroquine, cyclohexamide, didemnin B, γ-mangostin and linoleic acid were all able to inhibit viral CPE at concentrations that did not induce cytotoxicity. However, these drugs inhibited CPE at concentrations that induced cytomorbidity, indicating non-specific anti-viral activity. CONCLUSIONS: We describe the methodology for a simple in vitro drug screening assay that identifies potential anti-viral drugs via their ability to inhibit SARS-CoV-2-induced CPE. The additional growth assay illustrated how several drugs display anti-viral activity at concentrations that induce cytomorbidity. For instance, hydroxychloroquine showed anti-viral activity at concentrations that slow cell growth, arguing that its purported in vitro anti-viral activity arises from non-specific impairment of cellular activities. The cytomorbidity assay can therefore rapidly exclude potential false positives. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12985-021-01587-z.

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Masks and respirators, selection criteria for periodontal therapy: Challenges for a periodontist during COVID-19

Coronavirus disease-2019 (COVID-19) has created a pandemic, which has upgraded most medical services across the globe to the level of emergency preparedness and the highest infection control measures Use of personal protective equipment and masks along with respirators is possibly the only way to combat the spread and its use in areas where the personnel is in high-risk category offers a lifeline This review aimed to examine, summarize the available evidence related to use of masks and respirators, and possibly provide a recommendation for the periodontist and dental fraternity as a whole A literature search was conducted on the PubMed, PubMed Central, MEDLINE, and Embase databases with the keyword 'surgical masks,' 'COVID-19,' 'Respirators,' 'N95,' 'health care worker,' 'oral,' and 'dental treatment ' Masks and respirators offer prevention and control of the spread of the pandemic Respirators are found to be more effective than masks in the ability to prevent aerosol transmission to health care workers More studies are needed to be carried out to evaluate efficacy and vital characteristics of the respirators available to rule out any possibility of breach caused either by noncompliance or otherwise Although the virus transmission is caused by varied clinical presentations, the use of masks and respirators offers hope in reducing the risk of cross transmission both to the dentists and patients © 2020 Journal of International Oral Health Published by Wolters Kluwer Medknow

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Procalcitonin is a predictor of disseminated intravascular coagulation in patients with fatal COVID-19

OBJECTIVE: The coagulopathies that present with COVID-19 are thrombotic microangiopathy and disseminated intravascular coagulopathy (DIC). Procalcitonin (PCT) levels have been shown to be significantly increased in COVID-19 patients in comparison with healthy subjects/asymptomatic coronavirus-positive patients. In this report, our aim was to assess the associations of the PCT level with DIC and the severity of COVID-19 infection. PATIENTS AND METHODS: In this cross-sectional, retrospective study, 71 consecutive patients with severe COVID-19 (21 with DIC and 50 without DIC) were enrolled in the study. The PCT level was obtained from hospital records. RESULTS: The PCT level was significantly higher in the patients with DIC than in those without DIC [1.9 (0.6-14.5) vs. 0.3 (0.2-0.4) (ng/mL), p<0.01]. The PCT level showed a positive and significant correlation with DIC (r=0.382, p=0.001) and was an independent predictor of DIC in patients with severe COVID-19 (OR: 6.685, CI: 1.857-24.063, p<0.01). CONCLUSIONS: In summary, the PCT level was increased in severe COVID-19 patients with DIC compared with those without DIC. An increased PCT level might suggest the presence of DIC and may help in predicting COVID-19 severity.

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Effectiveness of a Family Support Intervention on Caregiving Burden in Family of Elderly Patients With Cognitive Decline After the COVID-19 Lockdown

Background: The coronavirus disease 2019 (COVID-19) pandemic had a great impact on patients with cognitive decline or dementia. The lockdown period may exacerbate behavioral disorders and worsen distress of caregivers. The aim of this study is to evaluate the effectiveness of a family support intervention on the negative effects that the COVID-19 lockdown may have on patients and related caregivers. Methods: We recruited patients whose related caregivers had attended a family support course before the COVID-19 lockdown. The course was for family members of patients with cognitive decline or dementia and consisted in eight meetings during which the participants received information about the disease, the management of neuropsychiatric symptoms, and community resources and services available for patients with dementia. Data on cognitive decline, neuropsychiatric symptoms, and functional status had been collected before the course with the Mini-Mental State Examination (MMSE), the Neuropsychiatric Inventory (NPI), and the Instrumental (IADL) and Basic (BADL) Activities of Daily Living scales, respectively. The caregiving burden had been evaluated at the end of the course by means of the Zarit Burden Interview (ZBI). After the COVID-19 lockdown, a phone interview was made to compare neuropsychiatric symptoms, functional status, and caregiver's burden with the previous evaluation. Results: There were no significant changes before and after the COVID-19 lockdown in the mean NPI score. The IADL, BADL, and ZBI scores were significantly lower after lockdown than before. The BADL scores were inversely associated with ZBI scores. Thus, despite a worsening of patients' functional status, the caregivers' burden decreased significantly probably due to the positive effect of the family support intervention. Conclusions: Our study demonstrated that a complete family support intervention for caregivers of patients with cognitive decline or dementia can reduce the burden of care even in a particular negative period, such as the COVID-19 lockdown.

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Use of mNUTRIC-Score for Nutrition Risk Assessment and Prognosis Prediction in Critically Ill Patients with COVID-19: A Retrospective Observational Study

INTRODUCTION: Nutritional risk is highly prevalent in patients with COVID-19. Relevant data on nutritional assessment in the critically ill population are scarce. This study was conducted to evaluate the modified Nutrition Risk in the Critically Ill (mNUTRIC)-Score as a mortality risk factor in mechanically ventilated patients with COVID-19. METHODS: We conducted this retrospective observational study in critically ill patients with COVID-19. Patients' characteristics and clinical information were obtained from electronic medical records. The nutritional risk for each patient was assessed at the time of mechanical ventilation using the mNUTRIC-Score. The major outcome was 28-day mortality. RESULTS: Ninety-eight patients were analyzed (mean age, 57.22 ± 13.66 years, 68.4% male); 46.9% of critically ill COVID-19 patients were categorized as being at high nutrition risk (mNUTRIC-Score of ≥5). A multivariate logistic regression model indicated that high nutritional risk has higher 28-day hospital mortality (OR = 4.206, 95% CI: 1.147–15.425, p=0.030). A multivariate Cox regression analysis showed that high-risk mNUTRIC-Score had a significantly increased full-length mortality risk during hospitalization (OR = 1.991, 95% CI: 1.219–3.252, p=0.006). CONCLUSION: The mNUTRIC-Score is an independent mortality risk factor during hospitalization in critically ill COVID-19 patients.

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Robust estimation of diagnostic rate and real incidence of COVID-19 for European policymakers

Policymakers need a clear and fast assessment of the real spread of the epidemic of COVID-19 in each of their respective countries. Standard measures of the situation provided by the governments include reported positive cases and total deaths. While total deaths immediately indicate that countries like Italy and Spain have the worst situation as of mid April 2020, on its own, reported cases do not provide a correct picture of the situation. The reason is that different countries diagnose diversely and present very distinctive reported case fatality rate (CFR). The same levels of reported incidence and mortality might hide a very different underlying picture. Here we present a straightforward and robust estimation of the diagnostic rate in each European country. From that estimation we obtain an uniform unbiased incidence of the epidemic. The method to obtain the diagnostic rate is transparent and empiric. The key assumption of the method is that the real CFR in Europe of COVID-19 is not strongly country-dependent. We show that this number is not expected to be biased due to demography nor the way total deaths are reported. The estimation protocol has a dynamic nature, and it has been giving converging numbers for diagnostic rates in all European countries as of mid April 2020. From this diagnostic rate, policy makers can obtain an Effective Potential Growth (EPG) updated everyday providing an unbiased assessment of the countries with more potential to have an uncontrolled situation. The method developed will be used to track possible improvements on the diagnostic rate in European countries as the epidemic evolves.

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Modeling and Analysis of the Dynamics of Covid-19 Transmission in Presence of Immigration and Vaccination

This paper aims to propose and study the dynamics of COVID-19 transmission model with immigration, vaccination and general incidence function. The global existence, positivity and boundedness of solutions are proved. Also, the sensitivity analysis is used to discover parameters that have impact on the threshold value of the basic reproduction number R0 . Furthermore, we construct appropriate Lyapunov functions to prove the global stability of equilibria. © 2022 the author(s).

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Human Augmentation Technologies for Employee Well-Being: A Research and Development Agenda

The COVID-19 pandemic has changed the style of work. In adapting to the changing work environment, human augmentation technologies (HAT) can provide employees with new options to support their work. However, the agenda for research and development of HAT for the new normal is still unclear. In this study, we set two research questions: (i) what type of technology demand has emerged among employees due to the COVID-19 pandemic; and (ii) what is the nature of job satisfaction experienced by employees during the COVID-19 pandemic? This study aims to clarify the technology demand and job satisfaction of employees during the COVID-19 pandemic. We analyzed data from in-depth interviews with employees based on a grounded theory approach to answer the research questions and proposed an agenda for the research and development of HAT to enhance employees’ well-being in this new normal based on the crosspoint of technology demand and job satisfaction. The theoretical contribution of this study is the development of models of technology demand and job satisfaction of employees during the COVID-19 pandemic. The practical contribution is the development of a crosspoint framework to enable the development of HAT to support work while considering their impact on employees’ well-being.

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Large uterus: what is the limit for a laparoscopic approach?

Hysterectomy is the most common surgical gynecologic procedure, which is frequently related to the treatment of leiomyoma. The laparoscopic hysterectomy is associated with a shorter hospital stay, fewer infection rates, and a faster return to daily activities. Most gynecologists do not recommend a hysterectomy via the vagina or a laparoscopic-assisted vaginal hysterectomy (LAVH) in the case of a uterus weighing more than 300 g. This case report presents the case of an LAVH undertaken in a 43-year-old patient with a uterus weighing 2,800 g. There are no definite guidelines concerning the procedure for a large uterus, and the literature is vague regarding the best surgical procedure for these cases. The size of the uterus does not seem to be an absolute contraindication for endoscopic surgery. This procedure relies entirely on the surgeon's ability.

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Natural Images Allow Universal Adversarial Attacks on Medical Image Classification Using Deep Neural Networks with Transfer Learning

Transfer learning from natural images is used in deep neural networks (DNNs) for medical image classification to achieve a computer-aided clinical diagnosis. Although the adversarial vulnerability of DNNs hinders practical applications owing to the high stakes of diagnosis, adversarial attacks are expected to be limited because training datasets (medical images), which are often required for adversarial attacks, are generally unavailable in terms of security and privacy preservation. Nevertheless, in this study, we demonstrated that adversarial attacks are also possible using natural images for medical DNN models with transfer learning, even if such medical images are unavailable; in particular, we showed that universal adversarial perturbations (UAPs) can also be generated from natural images. UAPs from natural images are useful for both non-targeted and targeted attacks. The performance of UAPs from natural images was significantly higher than that of random controls. The use of transfer learning causes a security hole, which decreases the reliability and safety of computer-based disease diagnosis. Model training from random initialization reduced the performance of UAPs from natural images; however, it did not completely avoid vulnerability to UAPs. The vulnerability of UAPs to natural images is expected to become a significant security threat.

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[Experience of Nurses in Charge of COVID-19 Screening at General Hospitals in Korea]

PURPOSE: The purpose of this study was to understand and describe the experiences of nurses in charge of COVID-19 screening at general hospitals in South Korea. METHODS: Data were collected through individual in-depth interviews with 14 nurses who had been working for more than a month at a screening clinic operated by two general hospitals from May 11 to July 20, 2021. Verbatim transcripts were analyzed using Colaizzi's phenomenological analysis. RESULTS: As a result of analysis, four theme clusters were extracted from nurses' experiences, as follow: the role of the hospital gatekeeper entrusted with managing the COVID-19 pandemic, struggling to maintain the protective barrier, boundlessness like a Mobius strip, and driving force to endure as a nurse in charge of COVID-19 screening. CONCLUSION: The results of this study provide a deeper understanding of the lives of screening clinic nurses who are struggling with the COVID-19 situation. The results are expected to be useful in providing basic data for improving the infection control system and response strategies that can be applied to nursing practice in other pandemic situations.

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The use of prone positioning in severe COVID-19 outside the intensive care unit.

OBJECTIVES It was aimed to demonstrate the applicability of the prone position with high-flow oxygen to COVID-19 patients with severe respiratory failure in the service in September when the number of cases and the need for intensive care were increased. MATERIAL AND METHODS The prone position was applied for a minimum of 30-minute periods for at least four hours a day. The patients' oxygen saturation levels and respiration rates were monitored before and 30 minutes after prone positioning. RESULTS Ten patients, nine males (9/1, M/F), were included in the study. Mean oxygen saturation at baseline was 75.8±12.14 (min: 50 %; max: 90 %) and all patients had high oxygen demand. The oxygen saturation of the patients differed significantly before and after (83.4±6.38 %; 90±5.31 %, p <0.001) prone positioning. Similarly, respiration rates differed significantly before and after (23.9±6; 21.4±4.97, p <0.001) prone positioning. Two patients died during treatment. CONCLUSION This study highlights the promise of prone positioning performed in ward conditions for improving oxygenation in COVID-19. While the study contains a small group, it may provide guidance for the clinical management of COVID-19 patients to prevent the need for intensive care in the challenging course of therapy (Tab. 2, Fig. 2, Ref. 15).

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Immune Checkpoint Inhibitors in Human Glioma Microenvironment

Gliomas are the most common primary brain tumors in adults. Despite the fact that they are relatively rare, they cause significant morbidity and mortality. High-grade gliomas or glioblastomas are rapidly progressing tumors with a very poor prognosis. The presence of an intrinsic immune system in the central nervous system is now more accepted. During the last decade, there has been no major progress in glioma therapy. The lack of effective treatment for gliomas can be explained by the strategies that cancer cells use to escape the immune system. This being said, immunotherapy, which involves blockade of immune checkpoint inhibitors, has improved patients’ survival in different cancer types. This novel cancer therapy appears to be one of the most promising approaches. In the present study, we will start with a review of the general concept of immune response within the brain and glioma microenvironment. Then, we will try to decipher the role of various immune checkpoint inhibitors within the glioma microenvironment. Finally, we will discuss some promising therapeutic pathways, including immune checkpoint blockade and the body’s effective anti-glioma immune response.

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Computational Study of Ions and Water Permeation and Transportation Mechanisms of the SARS-CoV-2 Pentameric E Protein Channel

Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus (SARS-CoV-2) and represents the causative agent of a potentially fatal disease that is of public health emergency of international concern. Coronaviruses, including SARS-CoV-2, encode an envelope (E) protein, which is a small, hydrophobic membrane protein; the E protein of SARS-CoV-2 has high homology with that of severe acute respiratory syndrome coronavirus. (SARS-CoV) In this study, we provide insights into the function of the SARS-CoV-2 E protein channel and the ion and water permeation mechanisms on the basis of combined in silico methods. Our results suggest that the pentameric E protein promotes the penetration of monovalent ions through the channel. Analysis of the potential mean force (PMF), pore radius and diffusion coefficient reveals that Leu10 and Phe19 are the hydrophobic gates of the channel. In addition, the pore demonstrated a clear wetting/dewetting transition with monovalent cation selectivity under transmembrane voltage, which indicates that it is a hydrophobic voltage-dependent channel. Overall, these results provide structural-basis insights and molecular-dynamic information that are needed to understand the regulatory mechanisms of ion permeability in the pentameric SARS-CoV-2 E protein channel.

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A preinstalled nasopharyngeal airway in the right nasal passageway to facilitate nasogastric intubation in anesthetized and intubated patients: a prospective randomized controlled trial.

BACKGROUND Nasogastric intubation (NGI) is usually challenging in patients under general anesthesia, with reported success rate at the first attempt to be less than 50%. The aim of this study was to investigate whether a preinstalled nasopharyngeal airway (NPA) in the right nasal passageway can facilitate NGI in anesthetized and intubated patients. METHODS A prospective randomized controlled trial including 108 patients scheduled for elective intra-abdominal surgeries requiring a nasogastric tube (NGT) was conducted. Fifty-three patients were randomized to receive NGI through a preinstalled NPA in the right nasal passageway (Group NPA) and 55 patients to receive NGI via the right nostril (Group O). The primary outcomes were success rates of NGI at first attempt, success rates of NGI in accumulative attempts, durations of successful NGI at the first attempt and success rates of NGI for the rescuing methods. The secondary outcomes were bleeding incidence and hemodynamic changes induced by NGI. RESULTS Success rate of NGI at the first attempt was 83.0% in Group NPA compared with 47.3% in Group O [P < 0.001; absolute risk reduction (ARR) = 35.7%, 95% confidence interval (CI) = 19.1-52.4%; relative risk reduction (RRR) = 67.8%] and success rate of NGI in accumulative attempts (two attempts maximum) was 88.7% in Group NPA compared with 63.6% in Group O (P = 0.002; ARR = 25.0%, 95% CI = 9.7-40.4%; RRR = 68.9%). Duration for NGI successful at the first attempt in Group NPA was significantly longer than that in Group O (56.3 vs. 27.1 s; P < 0.001; Mean difference = 29.2 s, 95% CI = 20.0-38.4 s). Neither bleeding incidence nor hemodynamic response is significantly different between the two study groups. CONCLUSIONS The study indicates a preinstalled NPA in the right nasal passageway facilitates NGI in anesthetized and intubated patients as an initial NGI method and as a rescuing method for patients undergoing two unsuccessful initial attempts of NGI without a preinstalled NPA. However, the NPA method proved to take more time than the routine method for NGI successful at the first attempt. TRIAL REGISTRATION The study was conducted after receiving approval from Institutional Review Board of Chang Gung Memorial Hospital, Linkou branch, Taiwan (registration number 201800138A3; April 11, 2018), and the clinicaltrials.gov (NCT03697642; Principal Investigator: Ting-Yang Huang; Date of registration: October 4, 2018; https://www.clinicaltrials.gov/NCT03697642 ).

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Considerations in the evaluation and management of oral potentially malignant disorders during the COVID-19 pandemic

AIM: The COVID-19 pandemic has resulted in society experiencing unprecedented challenges for health care practitioners and facilities serving at the frontlines of this pandemic. With regard to oral cancer, there is a complete absence of literature regarding the long-term impact of pandemics on patients with oral potentially malignant disorders (OPMDs). The objective of this article is to put forth an institutional multidisciplinary approach for the evaluation and management of OPMDs. METHODS: A multidisciplinary approach was put formalized within our institution to risk stratify patients based on need for in-person assessment vs telehealth assessment during the COVID-19 pandemic. RESULTS: With judicious risk stratification of patients based on clinical features of their OPMD and with consideration of ongoing mitigation efforts and regional pandemic impact, providers are able to safely care for their patients. CONCLUSIONS: The COVID-19 pandemic has required health care practitioners to make novel decisions that are new to us with development of creative pathways of care that focused on patient safety, mitigation efforts, and clinical management of disease processes. The care of patients with OPMDs requires special considerations especially as patients at high risk for severe COVID-19 illness are also higher risk for the development of OPMDs.

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COVID-19 Pandemic and Reimagination of Multilateralism through Global Health Diplomacy

The ongoing pandemic COVID-19 has made it very clear that no one is safe until everyone is safe. But how can everyone be safe when the pandemic has broken every nerve of the economy and put an extra burden on the already crippled healthcare systems in low-income countries? Thus, the pandemic has changed the orientation of domestic as well as global politics, with many geopolitical shifts. The exponential growing infected cases and more than four million deaths has demanded a global response in terms of multilateralism. However, declining multilateralism and the need for its reforms was a much-delayed response. Given this context, this paper aimed to link the decline of multilateralism in the face of the pandemic by highlighting various instances of its failure and success;and highlighting the need for its revival. The article critically examines and evaluates the responses of multilateralism and global health diplomacy (GHD) during the pandemic. The ongoing black swan kind of event (an unexpected event) has obligated global leadership to think in terms of the revival of multilateralism through GHD. Historically, multilateralism through GHD has been shown to play an important role in managing and combating pandemics. The article further discusses various theoretical aspects such as sovereignty and hegemonic stability theory as reasons for the failing of multilateralism. The paper concludes by emphasizing the importance of foresight in reviving multilateralism in the pursuit of a more sustainable future.

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Association between platelet indices and the severity of the disease and mortality in patients with COVID-19.

OBJECTIVE The aim of the study was to determine the association between platelet indices and disease severity, and outcomes of the patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a secondary hospital. PATIENTS AND METHODS 722 hospitalized patients who had positive rRT-PCR for SARS-CoV-2 and/or typical findings of COVID-19 at chest computed tomography (CT) were enrolled in this study. Initial platelet count (PLT) and indices, including mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), MPV/PCT, MPV/PLT, PDW/PLT, PDW/PCT on admission and the third day of hospitalization, and their relationship with disease severity and outcomes were evaluated retrospectively. RESULTS The mean age of the patients was 57.2±15.6 years (range: 16-94) and male/female ratio was 1.22. 81.9% of the patients had moderate and 11.8% had severe disease. 1.8% of the patients had thrombocytopenia at admission. The patients transferred to the intensive care unit (ICU) had significantly lower baseline lymphocyte counts, PLT, PCT, and 3rd day lymphocyte counts when compared with the patients in wards. ICU patients also had higher baseline CRP, LDH, ferritin, MPV/PCT, MPV/PLT, PDW/PLT, PDW/PCT ratios, and 3rd day PDW, CRP, LDH, and ferritin levels than the patients in wards. Mortality was associated with lower baseline lymphocyte counts, PLT, PCT, 3rd day lymphocyte counts and PCT. Higher baseline CRP, LDH, ferritin, MPV/PCT, PDW/PLT, PDW/PCT and 3rd day CRP, LDH, ferritin, procalcitonin, PDW, MPV/PCT, PDW/PLT, and PDW/PCT ratios were also associated with poor prognosis. CONCLUSIONS Platelet count and ratios were significantly associated with mortality in patients with COVID-19.

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Dissemination of Chlamydia trachomatis chronic genital tract infection in gamma interferon gene knockout mice.

Mice (C57BL/6), treated with progesterone and infected intravaginally with the mouse pneumonitis strain of Chlamydia trachomatis (MoPn), acquired genital tract disease that ascended from the endocervix to the uterine horns, oviducts, and ovaries in a temporal fashion before the occurrence of spontaneous microbiological resolution by about 28 days after infection. Surprisingly, dissemination of MoPn in small numbers to draining lymph nodes, the peritoneal cavity, spleen, liver, kidneys, and lungs occurred in normal mice during the early stages of disease (7 to 14 days) in a portion of infected animals but resolved from these tissues, by microbiological criteria, prior to resolution of genital tract involvement. In contrast, gamma interferon knockout (IFN-gamma KO) mice exhibited dissemination of infection to a greater extent and for longer periods in a variety of tissues, and a portion of infected IFN-gamma KO mice failed to microbiologically resolve their genital tract disease. By comparison, C57BL/6 SCID mice uniformly failed to resolve their genital tract disease and exhibited high levels of dissemination to all tissues tested for extended (50-day) periods of times. Interestingly, although IFN-gamma KO mice failed to completely clear organisms from their genital tracts, they exhibited an attenuated infection indistinguishable from that of heterozygous littermates when challenged 112 days after primary infection. These data support a role for IFN-gamma in containing dissemination of MoPn from the genital tract to extragenital sites and in the microbiological resolution of infection. Data also indicate that IFN-gamma is not required for modulating reinfections, which normally follow a shorter and less dramatic course.

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Elective surgery cancellations due to the COVID‐19 pandemic: global predictive modelling to inform surgical recovery plans

BACKGROUND: The COVID‐19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID‐19. METHODS: A global expert‐response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian beta‐regression model was used to estimate 12‐week cancellation rates for 190 countries. Elective surgical case‐mix data, stratified by specialty and indication (cancer versus benign surgery), was determined. This case‐mix was applied to country‐level surgical volumes. The 12‐week cancellation rates were then applied to these figures to calculate total cancelled operations. RESULTS: The best estimate was that 28,404,603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID‐19 (2,367,050 operations per week). Most would be operations for benign disease (90.2%, 25,638,922/28,404,603). The overall 12‐week cancellation rate would be 72.3%. Globally, 81.7% (25,638,921/31,378,062) of benign surgery, 37.7% (2,324,069/6,162,311) of cancer surgery, and 25.4% (441,611/1,735,483) of elective Caesarean sections would be cancelled or postponed. If countries increase their normal surgical volume by 20% post‐pandemic, it would take a median 45 weeks to clear the backlog of operations resulting from COVID‐19 disruption. CONCLUSIONS: A very large number of operations will be cancelled or postponed due to disruption caused by COVID‐19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to safely restore surgical activity. This article is protected by copyright. All rights reserved.

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Intérêt de la corticothérapie dans la prise en charge des patients atteints de pneumopathie grave à SARS-CoV-2

Introduction Au cours des pneumopathies à SARS-CoV-2, plusieurs stratégies thérapeutiques ont été proposées. La description d’une aggravation secondaire liée à un orage cytokinique a justifié l’utilisation de molécules anti-inflammatoires. Du fait de la disponibilité, du faible coût, de son utilisation dans d’autres pathologies infectieuses, les corticoïdes ont été proposés pour la prise en charge des patients à ce stade de l’infection. Nous avons analysé l’ensemble des données d’une cohorte de patients hospitalisés pour une infection grave à SARS-CoV-2. L’objectif principal était d’étudier l’effet des corticoïdes sur l’incidence de ces évènements graves : intubation orotrachéale (IOT) ou décès (DC). Matériels et méthodes Les données ont été recueillies de manière rétrospective chez les patients hospitalisés pour une infection grave documentée par PCR (81 %) ou scanner thoracique (93 %) entre le 15/03/2020 et le 15/04/2020. Nous avons inclus les patients avec un score OMS=5 et nécessitant un débit d’O2 supérieur à 3 L/min pour maintenir une saturation>94 %. Les patients décédés ou transférés en réanimation dans les 48heures suivant l’admission ont été exclus, ainsi que ceux inclus dans des protocoles thérapeutiques. La corticothérapie était administrée, après discussion pluridisciplinaire, à la posologie de 2mg/kg équivalent prednisone de j1 à j3 puis 1mg/kg les 3jours suivants. Les malades traités par corticoïdes (groupe CT) ont été comparés aux malades de même niveau de gravité pris en charge avant la mise en place de la RCP le 2 avril, et traités selon le même standard de soin (groupe sans CT). Le critère d’évaluation principal était la survenue d’une IOT ou le DC. Résultats Un total de 120 patients a été analysé : 39 dans le groupe CT, 81 dans le groupe sans CT. Les 2 groupes avaient la même moyenne d’âge (66,4±14 ans groupe CT, 66,1±15 ans groupe sans CT ; p =−0,9), même sexe ratio (p =0,4), même niveau d’atteinte sur le TDM, même paramètres d’inflammation à l’entrée (CRP 135±86mg/L groupe CT et 118±90mg/L groupe sans CT). Le nombre de patient en limitation de soin était le même dans chaque groupe, n =14 (35 %) groupe CT, n =27 (33 %) groupe sans CT (p =0,9). Le nombre de malades IOT ou DC était significativement différent dans le groupe CT n =9 (23 %), comparativement au groupe sans CT n =42 (53 %) avec p <0,01. Cette différence était plus importante chez les patients sans limitation de soins : groupe CT aucun IOT ou DC, groupe sans CT n =20 (37 %). La différence d’incidence d’IOT ou DC n’était pas significative dans le sous-groupe des patients limités, groupe CT n =9 (64 %) et groupe sans CT n =22 (81 %) IOT/DC (p =0,27). Conclusion Même si le nombre limité de patients, le caractère rétrospectif et monocentrique de l’étude ne permettent pas d’extrapoler les données, nous confirmons l’intérêt de la corticothérapie pour la prise en charge des patients atteints de pneumopathie à SARS-CoV-2 aigu, à la phase inflammatoire. Les bénéfices à long terme restent à être évalués.

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Registry of neurological manifestations due to coronavirus-19 (COVID-19)

COVID-19 disease has spread around the world since December 2019. Neurological symptoms are part of its clinical spectrum. Objective: To know the neurological manifestations in patients infected by COVID-19 in Argentina. Methods: Multicenter study conducted in adults, from May 2020 to January 2021, with confirmed COVID-19 and neurological symptoms. Demographic variables, existence of systemic or neurological comorbidities, the form of onset of the infection, alteration in complementary studies and the degree of severity of neurological symptoms were recorded. Results: 817 patients from all over the country were included, 52% male, mean age 38 years, most of them without comorbidities or previous neurological pathology. The first symptom of the infection was neurological in 56.2% of the cases, predominantly headache (69%), then anosmia/ageusia (66%). Myalgias (52%), allodynia/hyperalgesia (18%), and asthenia (6%) were also reported. 3.2% showed diffuse CNS involvement such as encephalopathy or seizures. 1.7% had cerebrovascular complications. Sleep disorders were observed in 3.2%. 6 patients were reported with Guillain Barré (GBS), peripheral neuropathy (3.4%), tongue paresthesia (0.6%), hearing loss (0.4%), plexopathy (0.3%). The severity of neurological symptoms was correlated with age and the existence of comorbidities. Conclusions: Our results, similar to those of other countries, show two types of neurological symptoms associated with COVID-19: some potentially disabling or fatal such as GBS or encephalitis, and others less devastating, but more frequent such as headache or anosmia that demand increasingly long-term care.

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Prevalence and characteristics of Brazilians aged 50 and over that received a doctor's diagnosis of COVID-19: the ELSI-COVID-19 initiative.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused over half a million deaths worldwide. Brazil has been particularly impacted, registering more than 1.3 million infections and 57,000 deaths by late June 2020. Aggregate numbers of cases are essential in modeling the epidemic and planning responses; however, more detailed analysis of risk factors associated with SARS-CoV-2 infection are needed. Our study provides an initial examination of characteristics associated with receiving a doctor's diagnosis of COVID-19 among a nationally representative sample of Brazilians aged 50 and over. Data are derived from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) and a telephone follow-up survey to ELSI-Brazil participants, known as the ELSI-COVID-19 initiative. The telephone survey was conducted between 26 May and 8 June 2020. Results show that about 2.4% (n = 70) of the sample reported being told by a doctor they had COVID-19, however, only about half of these individuals (n = 37) reported receiving a diagnostic confirmation from viral testing (RT-PCR). Demographic factors (aged 50-60 years), socioeconomic factors (lower household income), health-related factors (obesity, three or more chronic conditions), and geography (living in the Northern region of the country) were positively associated with reporting a COVID-19 diagnosis. Despite the descriptive and preliminary nature of these findings, results reported here suggest the need for more targeted approaches to enhance personal protection and provide greater viral testing options, especially for older, sicker and more vulnerable adults in Brazil.

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563. Tocilizumab in the Treatment of Critical COVID-19 Pneumonia

BACKGROUND: The anti-interleukin-6 receptor monoclonal antibody tocilizumab has been proposed as a treatment for COVID-19 pneumonia although the efficacy remains unknown. METHODS: Patients with COVID-19 confirmed by nasal swab PCR for SARS-CoV-2 who were admitted to Stony Brook University Hospital in Suffolk County, New York between March 10(th) and April 2(nd) and received tocilizumab while undergoing mechanical ventilation in any intensive care unit were retrospectively analyzed from data available in the electronic medical record. Baseline characteristics and clinical outcomes were compared to mechanically ventilated patients admitted during the same time period who received standard hospital protocol. RESULTS: Forty-five patients received tocilizumab compared to seventy controls. Mean dose of tocilizumab given was 4.8mg/kg and mean time to receipt from initial intubation was 2.5 days. Baseline demographic characteristics, inflammatory markers, treatment with corticosteroids, and SOFA scores were similar between the two cohorts (Table 1). Patients who received tocilizumab had significantly lower Charlson co-morbidity index (2.0 versus 3.0, p = 0.01) and higher temperature (38.7 C versus 38.2 C, p = 0.004) than controls. There was no significant association between receipt of tocilizumab and the rate of extubation within fourteen days (44.4 percent versus 34.2 percent; OR = 1.53, 95% C.I. 0.71 – 3.30), discharge from hospital (51.1 percent versus 40.0 percent; OR = 1.568, 95% C.I. 0.737 – 3.337), or mortality (31.1 percent versus 41.4 percent; OR = 0.639, 95% C.I. 0.290 – 1.4407) (Table 2). Patients who were administered tocilizumab within two days of intubation had increased likelihood of extubation within fourteen days compared to those who were treated later (OR = 3.50, 95% C.I. 1.01 – 12.18). There was no observed increased risk of secondary infection in patients given tocilizumab (28.9 versus 25.7, OR = 1.1736, 95% C.I. = 0.507 – 2.714). Table 1: Patient Demographics and Baseline Characteristics [Image: see text] Table 2: Primary Outcomes [Image: see text] CONCLUSION: Tocilizumab was not associated with a significant improvement in rate of extubation, hospital discharge, or reduction in mortality in this retrospective cohort study of mechanically ventilated patients with COVID-19 pneumonia. Further studies are needed to determine whether earlier treatment may result in improved outcomes. DISCLOSURES: All Authors: No reported disclosures

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COVID-19 Health system response monitor: Japan

The COVID-19 Health System Response Monitor presents findings from a systematic approach to collect and synthesise up-to-date information on Singapore’s policy response to the COVID-19 outbreak. This publication is part of the APO’s COVID-19 HSRM series which presents detailed information on country-specific responses to COVID-19, to facilitate easy comparisons of health systems and public health, and policy responses to COVID-19. It also aims to strengthen evidence on the global response to the pandemic and allow for easy comparison of activities at national and sub-national levels. The series is updated to reflect changes in the health systems and policies to the COVID-19 response.

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Prediction of Diabetes Mortality in Mexico City Applying Data Science

Around the world, diabetes is a disease that in recent years has had a significant increase in mortality rates. Currently, several countries consider diabetes an important public health problem, particularly Mexico. In this research work, the problem of mortality forecasting for the next 5 years in Mexico City was addressed by applying Data Science. For developing the application, an extension of the IBM methodology called Batch MFCD was used, which is oriented to the epidemiology domain. All the mortality and other data used in the research are from public and official databases and belong to the 1990–2019 interval. For forecasting we selected the Support Vector Regression (SVR) model, which allowed forecasting the mortality rates for Mexico City in the 2020–2024 interval. A decrease of the mortality rate for the 2017–2019 interval was observed for the actual data, and for the 2020–2024 interval it is forecasted that mortality will continue to decrease at a similar rate. It is worth mentioning that 2020 was an atypical year, because of the COVID-19 pandemic;therefore, it is foreseeable that its effect may affect the actual mortality rates in subsequent years. © 2021, Springer Nature Switzerland AG.

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SARS-CoV-2 from Urban to Rural Water Environment: Occurrence, Persistence, Fate and Influence on Agriculture Irrigation. A Review

The novel coronavirus disease (COVID-19), originating from China, has rapidly crossed borders, infecting people worldwide While its transmission may occur predominantly via aerosolization of virus-laden droplets, the possibility of other routes of contagion via the environment necessitates considerable scientific consideration SARS-CoV-2 viral RNA has been detected in the feces of infected persons, and studies also have reported its occurrence in wastewater and surface water bodies Therefore, water may be a possible route of virus outbreaks Agricultural irrigation is the largest use of water globally, accounting for 70% of water use worldwide Ensuring adequate water quality within irrigation practices is fundamental to prevent harm to plants and soils, maintain food safety, and protect public health This review aims to gather information on possible SARS-CoV-2 transmission routes within urban and rural water environments, looking into the detection, persistence, and fate of SARS-CoV-2 Based on published literature, the effect of current treatment technologies in wastewater treatment plants (WWTPs) on SARS-CoV-2 inactivation has also been investigated Preliminary research efforts that concentrated on SARS-CoV-2 indicate that the risk of virus transmission from the aquatic environment may currently be non-existent, although a few studies have reported the presence of SARS-CoV RNA in soils, whereas there are still no studies on the detection of SARS-CoV-2 in crops

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International electronic health record-derived COVID-19 clinical course profiles: the 4CE consortium

We leveraged the largely untapped resource of electronic health record data to address critical clinical and epidemiological questions about Coronavirus Disease 2019 (COVID-19). To do this, we formed an international consortium (4CE) of 96 hospitals across five countries (www.covidclinical.net). Contributors utilized the Informatics for Integrating Biology and the Bedside (i2b2) or Observational Medical Outcomes Partnership (OMOP) platforms to map to a common data model. The group focused on temporal changes in key laboratory test values. Harmonized data were analyzed locally and converted to a shared aggregate form for rapid analysis and visualization of regional differences and global commonalities. Data covered 27,584 COVID-19 cases with 187,802 laboratory tests. Case counts and laboratory trajectories were concordant with existing literature. Laboratory tests at the time of diagnosis showed hospital-level differences equivalent to country-level variation across the consortium partners. Despite the limitations of decentralized data generation, we established a framework to capture the trajectory of COVID-19 disease in patients and their response to interventions.

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Chloroquine-induced QTc prolongation in COVID-19 patients.

BACKGROUND In the battle against the SARS-CoV‑2 pandemic, chloroquine has emerged as a new potential therapeutic option for the treatment of infected patients. A safety consideration for the application of chloroquine is its QTc-prolonging potential. Thus far, no data are available on the QTc-prolonging potential of chloroquine in COVID-19 patients. OBJECTIVE To assess the degree of chloroquine-induced QTc prolongation in hospitalised COVID-19 patients. METHODS A baseline electrocardiogram (ECG) and ECGs recorded during chloroquine treatment were retrospectively collected in patients suspected of having COVID-19. The QTc interval was calculated by computerised and manual interpretation. Baseline and follow-up QTc intervals were compared using the paired samples t-test. RESULTS A total of 95 patients had a baseline ECG recording and at least one ECG recording during chloroquine therapy. Chloroquine treatment resulted in a mean QTc prolongation of 35 ms (95% CI 28-43 ms) using computerised interpretation and 34 ms (95% CI 25-43 ms) using manual interpretation. No torsade de pointes was observed during chloroquine treatment. After manual review, 22 patients (23%) had a QTc interval exceeding 500 ms during chloroquine treatment. None of these patients had a prolonged QTc interval prior to the initiation of chloroquine treatment. CONCLUSIONS Chloroquine significantly prolongs the QTc interval in a clinically relevant matter. This highlights the need for ECG monitoring when prescribing chloroquine to COVID-19 patients.

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The effect of social distance measures on COVID-19 epidemics in Europe: an interrupted time series analysis

Following the introduction of unprecedented "stay-at-home" national policies, the COVID-19 pandemic recently started declining in Europe. Our research aims were to characterize the changepoint in the flow of the COVID-19 epidemic in each European country and to evaluate the association of the level of social distancing with the observed decline in the national epidemics. Interrupted time series analyses were conducted in 28 European countries. Social distance index was calculated based on Google Community Mobility Reports. Changepoints were estimated by threshold regression, national findings were analyzed by Poisson regression, and the effect of social distancing in mixed effects Poisson regression model. Our findings identified the most probable changepoints in 28 European countries. Before changepoint, incidence of new COVID-19 cases grew by 24% per day on average. From the changepoint, this growth rate was reduced to 0.9%, 0.3% increase, and to 0.7% and 1.7% decrease by increasing social distancing quartiles. The beneficial effect of higher social distance quartiles (i.e., turning the increase into decline) was statistically significant for the fourth quartile. Notably, many countries in lower quartiles also achieved a flat epidemic curve. In these countries, other plausible COVID-19 containment measures could contribute to controlling the first wave of the disease. The association of social distance quartiles with viral spread could also be hindered by local bottlenecks in infection control. Our results allow for moderate optimism related to the gradual lifting of social distance measures in the general population, and call for specific attention to the protection of focal micro-societies enriching high-risk elderly subjects, including nursing homes and chronic care facilities.

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Safety and Immunogenicity of a Newcastle Disease Virus Vector-Based SARS-CoV-2 Vaccine Candidate, AVX/COVID-12-HEXAPRO (Patria), in Pigs

Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were developed in record time and show excellent efficacy and effectiveness against coronavirus disease 2019 (COVID-19). However, currently approved vaccines cannot meet the global demand. In addition, none of the currently used vaccines is administered intranasally to potentially induce mucosal immunity. Here, we tested the safety and immunogenicity of a second-generation SARS-CoV-2 vaccine that includes a stabilized spike antigen and can be administered intranasally. The vaccine is based on a live Newcastle disease virus vector expressing a SARS-CoV-2 spike protein stabilized in a prefusion conformation with six beneficial proline substitutions (AVX/COVID-12-HEXAPRO; Patria). Immunogenicity testing in the pig model showed that both intranasal and intramuscular application of the vaccine as well as a combination of the two induced strong serum neutralizing antibody responses. Furthermore, substantial reactivity to B.1.1.7, B.1.351, and P.1 spike variants was detected. Finally, no adverse reactions were found in the experimental animals at any dose level or delivery route. These results indicate that the experimental vaccine AVX/COVID-12-HEXAPRO (Patria) is safe and highly immunogenic in the pig model.

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Genetics Insight for COVID-19 Susceptibility and Severity: A Review

Coronavirus disease (COVID-19) presents a broad spectrum of clinical manifestations ranging from an asymptomatic to a severe clinical course. The host genetic background influence on the susceptibility and outcome of multiples infectious diseases has been previously reported. Herein, we aimed to describe relevant identified genetic variants and those potentially related to the inter-individual variability of COVID-19 susceptibility and/or severity considering the physiopathological pathway of the disease The HLA-A*25:01, -B*15:27, -B*46:01, -C*01:02, and -C*07:29 alleles have been associated with COVID-19 susceptibility; while HLA-A*02:02, -B*15:03, and -C*12:03 have been identified as low-risk alleles. Variants in cytokine genes such as IL1B, IL1R1, IL1RN, IL6, IL17A, FCGR2A, and TNF could be related to disease susceptibility and cytokine storm, and/or COVID-19 complications (e.g., venous thrombosis). Several variants in ACE2 and TMPRSS2 affecting the expression of the receptors related to COVID-19 have been associated with the disease susceptibility and risk factors. Finally, two GWAS have identified the loci 3p21.31 (LZTFL1, SLC6A20, CCR9, FYCO1, CXCR6, and XCR1) and 9q34.2 (ABO) with COVID-19 severity. Heterogeneous results in the association of genetic variants with COVID-19 susceptibility and severity were observed. The mechanism of identified risk-genes and studies in different populations are still warranted.

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Clinical Prognosis of Right-Sided Infective Endocarditis not Associated with Cardiac Devices or Intravenous Drug use: a Cohort Study and Meta-Analysis.

Right-sided infective endocarditis (RSIE), classically associated with intravenous drug use or intracardiac devices, is considered a good-prognosis infective endocarditis (IE) form. However, predisposing factors and prognosis for "NODID" RSIE (NOt associated with cardiac Devices or Intravenous Drug use) remain unclear. The aim of this study was to evaluate predisposing factors and prognosis of NODID RSIE compared to other RSIE forms. A retrospective cohort study (January 2008-January 2019) was conducted in a reference center on 300 patients diagnosed with IE. Endocarditis-related events were defined as related to IE in mortality or open-heart surgery during follow-up. A review and meta-analysis of associated literature (January 2008-January 2019) were also performed. Fifty-seven patients presented RSIE (19%), 22 of which were NODID RSIE (39%). Use of intravascular catheters (23% vs 3%; p = 0.027) and congenital heart diseases (18% vs 0%; p = 0.019) were associated with NODID RSIE. This group had a higher in-hospital mortality (23% vs 3%; p = 0.027) and endocarditis-related event rates (41% vs 6%; p = 0.001) than non-NODID RSIE. Furthermore, NODID RSIE was independently associated with in-hospital endocarditis-related events (OR = 19.29; 95%CI:2.23-167.16; p = 0.007). Our meta-analysis evaluated four studies and identified 96 cases (30%) of NODID RSIE from 320 total RSIE cases. NODID RSIE patients demonstrated higher in-hospital mortality (RR = 2.81; 95%CI:1.61-4.90; p < 0.001; I2 = 0.0%) and necessity of open-heart surgery (RR = 13.89; 95%CI:4.14-46.60; p < 0.001; I2 = 0.0%) than non-NODID RSIE cases. Our study suggests that NODID RSIE has the highest endocarditis-related event rate and in-hospital mortality among RSIE cases and therefore should not be considered a good-prognosis IE.

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Voices from the Field: The Impact of COVID-19 on Early Career Scholars and Doctoral Students

This joint report from the American Educational Research Association (AERA) and the Spencer Foundation explores the impact of the COVID-19 pandemic on early career scholars and doctoral students in education research. The report presents findings and recommendations based on a focus group study held in May and June of 2020. The purpose of the study was to listen to and learn from the experiences of education researchers. The study included separate groups of scholars of color, women of color, and doctoral students of color, given that the COVID-19 crisis was highly racialized and having a disproportionate impact on communities of color. The aim of the report is to provide information that higher education institutions, agencies funding research, professional associations, and other research organizations can use to support the next generation of researchers and help buffer or contain adverse impacts to them. The report offers seven recommendations that could help to foster institutional and organizational responses to COVID-19 that are equitable and enriching. It is part of an ongoing initiative by AERA and Spencer to survey and assess the pressing needs of early career scholars and doctoral students at this pernicious time of a national pandemic.

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Caremongering and Assumptions of Need: The Spread of Compassionate Ageism During COVID-19

The Coronavirus Disease 2019 (COVID-19) pandemic has highlighted the pervasive ageism that exists in our society. Although instances of negative or hostile ageism have been identified, critical attention to the nuances of ageism throughout the pandemic, such as the prevalence and implications of positive or compassionate ageism, has lagged in comparison. This commentary uses stereotype content theory to extend the conversation regarding COVID-19 and ageism to include compassionate ageism. We offer the ‘caremongering’ movement, a social movement driven by social media to help individuals impacted by COVID-19, as a case study example that illustrates how compassionate ageism has manifested during the pandemic. The implications of compassionate ageism that have and continue to occur during the pandemic are discussed using stereotype embodiment theory. Future actions that focus on shifting attention from the intent of ageist actions and beliefs to the outcomes for those experiencing them is needed. Further, seeking older individuals’ consent when help is offered, recognizing the diversity of aging experiences, and thinking critically about ageism in its multiple and varied forms are all required.

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Revitalization Education in Problem Areas as a Tool for the Implementation of Social Welfare

Achieving social well-being in problem areas requires social and economic activation, which is made possible by a change in the attitudes and behavior of the area’s inhabitants. In this systematic review article, the author points out that in order for current public interventions for people at risk in problem areas to be effective, the use of available research by neurobiologists is required. To this end, the author: (1) made a synthetic characterization of problem areas in the world, with particular emphasis on social challenges;(2) reviewed both the available research written by neuroscientists and their subsequent conclusions, which may contribute to better explanations of the social consequences of transformation;(3) on this basis, the author formulated conclusions and recommendations for decision makers. In addition, a review of available research by neuroscientists will help to understand why efforts so far targeting marginalized social groups have been ineffective or insufficient. Revitalization education is defined as all the processes and interactions that aim to change the attitudes and behaviors of people, in particular children and adolescents, in order to contribute to the integration and inclusion of people at risk of social exclusion, and thus improve their well-being. Revitalization education should be directed at people who are caught up in a negative loop of social patterns. Since their fate is shaped by the influence of parents and teachers, the method used for reconstructing positive life patterns towards prodevelopment skills and competences should also be directed at these groups. The article discusses: social problems of marginalized areas;the impact of neuroscience on economic decision making;and recommendations formulated for educational activities.

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