title: Enhanced Humoral Response to Influenza Vaccine in Aged Mice with A Novel Adjuvant, rOv-ASP-1

text: Immunization is the best way to prevent seasonal epidemics and pandemics of influenza. There are two kinds of influenza vaccines available in the United States: an inactivated vaccine (TIV) and an attenuated vaccine; however, only TIV is approved for immunization of the elderly population. While the aged population has the highest rate of influenza vaccination, the protective efficacy is low as evidenced by elderly individuals having the highest mortality associated with influenza. Recently, we reported that an adjuvant derived from the helminth parasite Onchocerca volvulus, named O. volvulus activation-associated secreted protein-1 (Ov-ASP-1), can significantly enhance the protective efficacy of an inactivated vaccine (TIV) in young adult mice. In the current study, we examined whether this recombinant Ov-ASP-1 (rOv-ASP-1) can enhance the efficacy of TIV in aged mice as well. While primary immunization with TIV alone produced only a low level of influenza-specific antibodies (total IgG, IgG1, and IgG2c) in aged mice, the antibody levels were significantly increased after immunization with TIV+rOv-ASP-1. More importantly, the level of the total IgG in aged mice administered TIV+rOv-ASP-1 was comparable to that of young adult mice immunized with TIV alone. Co-administration of rOv-ASP-1 induced a low level of crossreactive antibody and enhanced the protective efficacy of TIV in aged mice, reflected by significantly increased survival after challenge with a heterologous influenza virus. rOv-ASP-1 was also superior to the conventional adjuvant alum in inducing specific IgG after TIV immunization in aged mice, and in conferring protection after challenge. These results demonstrate that rOv-ASP-1 may serve as a potential adjuvant for influenza vaccine to improve the efficacy of protection in the elderly.


title: A multicentre collaboration to investigate the cause of severe acute respiratory syndrome

text: Summary Severe Acute respiratory syndrome is a new disease in human beings, first recognised in late February, 2003, in Hanoi, Vietnam. The severity of the disease, combined with its rapid spread along international air-travel routes, prompted WHO to set up a network of scientists from 11 laboratories around the world to try to identify the causal agent and develop a diagnostic test. The network unites laboratories with different methods and capacities to rapidly fulfil all postulates for establishing a virus as the cause of a disease. Results are shared in real time via a secure website, on which microscopy pictures, protocols for testing, and PCR primer sequences are also posted. Findings are discussed in daily teleconferences. Progress is further facilitated through sharing between laboratories of samples and test materials. The network has identified a new coronavirus, consistently detected in samples of SARS patients from several countries, and conclusively named it as the causative agent of SARS; the strain is unlike any other known member of the genus Coronavirus. Three diagnostic tests are now available, but all have limitations.


title: Measurement of neutralizing antibody responses against H5N1 clades in immunized mice and ferrets using pseudotypes expressing influenza hemagglutinin and neuraminidase

text: Abstract Neutralizing antibody is associated with the prevention and clearance of influenza virus infection. Microneutralization (MN) and hemagglutination inhibition (HI) assays are currently used to evaluate neutralizing antibody responses against human and avian influenza viruses, including H5N1. The MN assay is somewhat labor intensive, while HI is a surrogate for neutralization. Moreover, use of replication competent viruses in these assays requires biosafety level 3 (BSL-3) containment. Therefore, a neutralization assay that does not require BSL-3 facilities would be advantageous. Toward this goal, we generated a panel of pseudotypes expressing influenza hemagglutinin (HA) and neuraminidase (NA) and developed a pseudotype-based neutralization (PN) assay. Here we demonstrate that HA/NA pseudotypes mimic release and entry of influenza virus and that the PN assay exhibits good specificity and reveals quantitative difference in neutralizing antibody titers against different H5N1 clades and subclades. Using immune ferret sera, we demonstrated excellent correlation between the PN, MN, and HI assays. Thus, we conclude that the PN assay is a sensitive and quantifiable method to measure neutralizing antibodies against diverse clades and subclades of H5N1 influenza virus.


title: Review of Clay-Drug Hybrid Materials for Biomedical Applications: Administration Routes

text: Focus here is placed on the pharmaceutical and biomedical applications of novel clay-drug hybrid materials categorized by methods of administration. Clay minerals have been used for many years as pharmaceutical and medicinal ingredients for therapeutic purposes. A number of studies have attempted to explore clay-drug hybrid materials for biomedical applications with desired functions, such as sustained release, increased solubility, enhanced adsorption, mucoadhesion, biocompatibility, targeting, etc. The present review attempts not only to summarize the state-of-the-art of clay-drug hybrid materials and their advantages, depending on the methods of administration, but also to deal with challenges and future perspectives of clay mineral-based hybrids for biomedical applications.


title: Estimating the germicidal effect of upper-room UVGI system on exhaled air of patients based on ventilation efficiency

text: Abstract Upper room (UR)-ultraviolet germicidal (UVGI) systems, one of several disinfection applications of UV, target airborne infectious diseases in rooms of buildings such as healthcare facilities. Previous studies have introduced many experiments showing the germicidal effect of UR-UVGI systems. In this study, a novel numerical method of estimating the germicidal effect of UR-UVGI systems for air exhaled by ward patients was introduced. The method adopts and modifies the concept of ventilation efficiency because the germicidal effect depends upon how the air containing airborne infectious particles flows and stays within UV-radiated area. A case study based on a four-patient ward showed that UV doses were correlated with the age of the air exhaled by a source patient, as expected. Moreover, the UV doses were considerably affected by the position of the UR-UVGI system. Inactivation rates of the influenza virus estimated using the UV doses, were in the range of 48–74%, and those of Mycobacterium tuberculosis were 68–90% in the breathing area of a neighboring patient. The results indicate not directly the decreased concentration of airborne infectious particles, but the possibility of inactivation caused by the UR-UVGI system, which is useful for system optimization.


title: Flu Vaccination Attitudes, Behaviours, and Knowledge among Health Workers

text: The aim of this work is to evaluate the attitudes, behaviours, and knowledge of health workers employed at an Italian University Hospital on the topic of vaccinations and in regard to flu vaccination. To this end, the study provided for the articulation of a computerised questionnaire on the digital platform EUSurvey which was administered online via e-mail to a sample of 457 health workers, in the period between November 2018 and March 2019. The data were subjected to descriptive and inferential statistical analysis. In particular, a logistic regression analysis was carried out in order to evaluate the relationship between the variables collected and the dichotomous outcome (vaccinated/unvaccinated subjects in the 2018–2019 season). The results, in line with what has been reported by the literature, highlighted that vaccine hesitancy is prevalent also among health workers. Furthermore, according to our study, only 30.6% of the health care workers had the flu vaccination. The survey points out the need to plan educational and informative interventions aimed at changing the attitudes, behaviours, and knowledge of health workers in the field of flu vaccination, for the purpose of protecting the health of healthcare personnel and their patients.


title: Coronavirus pandemic and tourism: Dynamic stochastic general equilibrium modeling of infectious disease outbreak

text: • We propose a DSGE model to examine the impact of the coronavirus outbreak on tourism. • The model is generalizable to any epidemic. • The model supports the policy of providing tourism consumption vouchers for residents.


title: Universal use of face masks for success against COVID-19: evidence and implications for prevention policies

text: Cloth masks are a simple, economic and sustainable alternative to surgical mask as a means of source control of SARS-CoV-2 for general community.


title: Local siRNA delivery by non-viral vectors

text: Since the discovery of the RNA interference (RNAi) phenomenon, RNAi-based therapies now present a huge potential for the treatment of many diseases, including inflammatory and infectious diseases and cancers. While numerous reports have described the development of small interfering RNA (siRNA) delivery systems for in-vivo applications, only a small number of siRNA-based therapies are currently under clinical development. This is essentially due to the lack of efficient and safe siRNA delivery systems for intravenous administration. However, the delivery of siRNA after local injection could represent an attractive route of administration to limit the issues of toxicity associated with systemic injection. We will describe here the different synthetic vectors which have been developed for the local delivery of siRNA in various organs.


Communication, coaching, and connection: The 3Cs for community cohesion during a crisis


title: High-Mannose Specific Lectin and Its Recombinants from a Carrageenophyta Kappaphycus alvarezii Represent a Potent Anti-HIV Activity Through High-Affinity Binding to the Viral Envelope Glycoprotein gp120

text: We previously reported that a high-mannose binding lectin KAA-2 from the red alga Kappaphycus alvarezii, which is an economically important species and widely cultivated as a source of carrageenans, had a potent anti-influenza virus activity. In this study, the full-length sequences of two KAA isoforms, KAA-1 and KAA-2, were elucidated by a combination of peptide mapping and cDNA cloning. They consisted of four internal tandem-repeated domains, which are conserved in high-mannose specific lectins from lower organisms, including a cyanobacterium Oscillatoria agardhii and a red alga Eucheuma serra. Using an Escherichia coli expression system, an active recombinant form of KAA-1 (His-tagged rKAA-1) was successfully generated in the yield of 115 mg per a litter of culture. In a detailed oligosaccharide binding analysis by a centrifugal ultrafiltration-HPLC method with 27 pyridylaminated oligosaccharides, His-tagged rKAA-1 and rKAA-1 specifically bound to high-mannose N-glycans with an exposed α1-3 mannose in the D2 arm as the native lectin did. Predicted from oligosaccharide-binding specificity, a surface plasmon resonance analysis revealed that the recombinants exhibit strong interaction with gp120, a heavily glycosylated envelope glycoprotein of HIV with high association constants (1.48–1.61 × 10(9) M(−1)). Native KAAs and the recombinants inhibited the HIV-1 entry at IC(50)s of low nanomolar levels (7.3–12.9 nM). Thus, the recombinant proteins would be useful as antiviral reagents targeting the viral surface glycoproteins with high-mannose N-glycans, and the cultivated alga K. alvarezii could also be a good source of not only carrageenans but also this functional lectin(s).


Salutogenesis: The Defining Concept for a New Healthcare System


title: Long‐term coexistence of SARS‐CoV‐2 with antibody response in COVID‐19 patients

text: Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection causing coronavirus disease 2019 (COVID‐19) has spread worldwide. Whether antibodies are important for the adaptive immune responses against SARS‐CoV‐2 infection needs to be determined. Here, 26 cases of COVID‐19 in Jinan, China, were examined and shown to be mild or with common clinical symptoms, and no case of severe symptoms was found among these patients. Strikingly, a subset of these patients had SARS‐CoV‐2 and virus‐specific IgG coexist for an unexpectedly long time, with two cases for up to 50 days. One COVID‐19 patient who did not produce any SARS‐CoV‐2–bound IgG successfully cleared SARS‐CoV‐2 after 46 days of illness, revealing that without antibody‐mediated adaptive immunity, innate immunity alone may still be powerful enough to eliminate SARS‐CoV‐2. This report may provide a basis for further analysis of both innate and adaptive immunity in SARS‐CoV‐2 clearance, especially in nonsevere cases.


title: Robotic‐assisted percutaneous coronary intervention in a COVID‐19 patient

text: Coronavirus disease‐2019 (COVID‐19) pandemic is the biggest global health threat in the 21st century. We describe a case of a patient with suspected COVID‐19 who needed urgent coronary artery interrogation, in which we utilized robotic assistance to minimize the risk of exposure to COVID‐19 and reduced personal protective equipment needed by the procedural team.


title: Oral drug repositioning candidates and synergistic remdesivir combinations for the prophylaxis and treatment of COVID-19

text: The ongoing pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), necessitates strategies to identify prophylactic and therapeutic drug candidates for rapid clinical deployment. A high-throughput, high-content imaging assay of human HeLa cells expressing the SARS-CoV-2 receptor ACE2 was used to screen ReFRAME, a best-in-class drug repurposing library. From nearly 12,000 compounds, we identified 66 compounds capable of selectively inhibiting SARS-CoV-2 replication in human cells. Twenty-four of these drugs show additive activity in combination with the RNA-dependent RNA polymerase inhibitor remdesivir and may afford increased in vivo efficacy. We also identified synergistic interaction of the nucleoside analog riboprine and a folate antagonist 10-deazaaminopterin with remdesivir. Overall, seven clinically approved drugs (halofantrine, amiodarone, nelfinavir, simeprevir, manidipine, ozanimod, osimertinib) and 19 compounds in other stages of development may have the potential to be repurposed as SARS-CoV-2 oral therapeutics based on their potency, pharmacokinetic and human safety profiles.


title: Failure of early extubation among cases of coronavirus disease-19 respiratory failure: Case report and clinical experience

text: RATIONALE: Extubation strategy for mechanically ventilated patients with Coronavirus Disease 19 is different from that for patients with other viral pneumonia. We reported 2 cases of Coronavirus Disease 19 receiving tracheal intubation twice during the hospitalization. PATIENT CONCERNS: Two elderly patients with onset of fever and upper respiratory tract infection were confirmed as Coronavirus Disease 19, 1 of whom had chronic obstructive pulmonary disease previously. With active antiviral and noninvasive respiratory supportive therapy, there was no improvement, thus mechanical ventilation (MV) was adopted. Combining with symptomatic and supportive treatment, their oxygenation recovered and then extubation was carried out. However, 96 hours later, they underwent endotracheal intubation again due to their Coronavirus Disease 19 progression. DIAGNOSIS: Critically ill Coronavirus Disease 19 requiring tracheal intubation owing to respiratory failure with lung.javascript. INTERVENTIONS: Initial Strategy for respiratory failure included endotracheal intubation, MV, antiviral treatment and cortisol in both cases. When extubation criteria were satisfied, early discontinuation of MV was conducted, then rehabilitation exercise and nutritional support followed. However, 96 hours later, the disease progressed leading to respiratory failure again, thus reintubation was performed. Later, veno-venous extracorporeal membrane oxygenation was performed owing to aggravation of respiratory failure, assisted by prone position treatment and sputum drainage, then status became stable and stepped into recovery stage. OUTCOMES: Both patients underwent reintubation, and their MV time and Intensive care unit residence time were prolonged. Through prone position treatment, sputum drainage and awake extracorporeal membrane oxygenation strategy, patient has been transferred to rehabilitation unit in Case 1, and patient in Case 2 has been in recovery stage as well with stable pulmonary status and was expected to receive evaluation in recent future. LESSONS: Course of Coronavirus Disease 19 is relatively longer, and failure rate of simple early extubation seemes higher. To reduce the likelihood of reintubation and iatrogenic injury, individualized assessment is recommended.


title: Early detection of SARS-CoV-2 antibodies in COVID-19 patients as a serologic marker of infection

text: BACKGROUND: Thousands of medical staff had been infected with SARS-CoV-2 virus with hundreds of deaths reported. Such loss could be prevented if there is a serologic assay for SARS-CoV-2-specific antibodies for serological surveillance of its infection at the early stage of disease. METHODS: Using CHO cell expressed full length SARS-CoV-2 S1 protein as capturing antigen, a COVID-19/SARS-CoV-2 S1 serology ELISA kit was developed and validated with negative samples collected prior to the outbreaks or during the outbreak, and positive samples from patients confirmed with COVID-19. RESULTS: The specificity of the ELISA kit was 97.5%, as examined against total 412 normal human samples. The sensitivity was 97.1% by testing against 69 samples from hospitalized and/or recovered COVID-19 patients. The overall accuracy rate reached 97.3%. The assay was able to detect SARS-CoV-2 antibody on day one after the onset of COVID-19 disease. The average antibody levels increased during the hospitalization and after been discharged for two weeks. SARS-CoV-2 antibodies were detected in 28 out of 276 asymptomatic medical staff and one out of five nucleic acid test-negative “Close contacts” of COVID-19 patient. CONCLUSION: With the assays developed here, we can screen medical staff, in-coming patients, passengers and people who are in close contact with the confirmed patients to identify the “innocent viral spreaders”, protect the medical staff and stop the further spreading of the virus.


title: A Case of Asymptomatic, Localized, and Idiopathic Diffuse Alveolar Damage

text: Diffuse alveolar damage (DAD) is a histological change in lung tissue, and is generally caused by an acute lung injury, which is characterized by bilateral and widespread damages. Localized DAD occurs very rarely. The causes for DAD are numerous, but the chief cause is acute interstitial pneumonia or acute exacerbation of idiopathic interstitial pneumonia, in cases of idiopathic manifestation. The 82-year-old patient, in this case study, showed a DAD lesion in only 1 lobe. The patient was otherwise healthy, with no previous symptoms of DAD. He was admitted to our medical center owing to localized infiltration, observed on his chest radiograph. Laboratory studies showed no signs of infections. DAD was confirmed by a surgical lung biopsy. The patient received corticosteroid treatment and had gradually improved. We report the case of a patient with localized, idiopathic DAD that cannot be classified as acute interstitial pneumonia or acute exacerbation of idiopathic interstitial pneumonia.


Pandemia por Covid-19: el mayor reto de la historia del intensivismo


title: Real-Time Quantitative Fluorescent Reverse Transcriptase-PCR for Detection of Severe Acute Respiratory Syndrome-Associated Coronavirus RNA

text: Aim: SARS-associated coronavirus (SARS-CoV) has been confirmed as the pathogen for severe acute respiratory syndrome (SARS). The aim of our study was to construct a sensitive and specific real-time quantitative fluorescent (QF) reverse transcriptase (RT)-PCR method for the detection of SARS-CoV RNA. Methods: Stored blood specimens from 44 patients with confirmed SARS were used along with blood samples from two sets of controls, 30 healthy volunteers who had no contact with SARS patients, and 30 healthy doctors and nurses who had contact with SARS patients but were without symptoms of SARS. Two pairs of primers were synthesized by the Shanghai Sangon Company according to SARS-CoV BJ01 strain sequence (AY278488), and then a pair of primers were designed and compared with a pair of primers published by WHO. Results: Using serial dilutions of SARS-CoV, the 44 blood samples from SARS patients specimens were tested. Using a 0.01% dilution of SARS-CoV, all 44 clinical samples tested positive in our assay. In comparison, using a 0.1% dilution of SARS-CoV, 26 of the 44 samples tested positive using the WHO primers. In the QF-RT-PCR assay, there was a linear amplification from 100 copies to 10(8) copies of the control RNA per RT-PCR and at least 10 copies, and sometimes even 1 copy, of target RNA tested positive in our assay. Conclusion: The primer we developed is sufficiently sensitive and specific to diagnose symptomatic SARS-CoV infections and for monitoring virus load.


title: Association between syphilis seroprevalence and age among blood donors in Southern China: an observational study from 2014 to 2017

text: OBJECTIVE: This study investigated the association between syphilis seroprevalence and age among blood donors, and described the distribution of serological titres among syphilis-infected donors, aiming to confirm the syphilis epidemic characteristics and to promote effective interventions for older adults. METHODS: Data were obtained from the Shenzhen Programme for Syphilis Prevention and Control in 2014–2017. Blood samples were screened using the ELISAs, and confirmed using the Treponema pallidum particle agglutination assay (TPPA) and toluidine red unheated serum test (TRUST). RESULTS: Among 394 792 blood donors, 733 tested TPPA and TRUST positive (active infection), and 728 tested only TPPA positive (historical infection). The overall prevalence of syphilis seropositivity was 370.1 per 100 000 (95% CI 351.1 to 389.0 per 100 000); the prevalence of active infection was 185.7 per 100 000 (95% CI 172.2 to 199.1 per 100 000). People aged ≥45 years displayed a prevalence of 621.8 per 100 000 in syphilis seropositivity and 280.5 per 100 000 in active infection, which were 3.8 times and 2.4 times higher than that for people aged <25 years, respectively. The prevalence of syphilis seropositivity (χ(2) (trend)=311.9, p (trend)<0.001) and active infection (χ(2) (trend)=72.1, p (trend)<0.001) increased significantly with age. After stratification by gender and year of donation, the increasing trend of prevalence with age remained (p (trend)<0.05), except for the prevalence of active infection in males and females in 2014. About 16.3% of donors with active infection and aged ≥45 years had a TRUST titre of ≥1∶8, lower than that of patients aged <25 years (51.3%) and 25–34 years (34.1%). CONCLUSIONS: The findings confirm the high prevalence of syphilis among older adults, and suggest the need to increase awareness among healthcare providers and deliver more targeted prevention interventions for older adults to promote early testing.


title: Population Genetics of SARS-CoV-2: Disentangling Effects of Sampling Bias and Infection Clusters

text: A novel RNA virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for the ongoing outbreak of coronavirus disease 2019 (COVID-19). Population genetic analysis could be useful for investigating the origin and evolutionary dynamics of COVID-19. However, due to extensive sampling bias and existence of infection clusters during the epidemic spread, direct applications of existing approaches can lead to biased parameter estimations and data misinterpretation. In this study, we first present robust estimator for the time to the most recent common ancestor (TMRCA) and the mutation rate, and then apply the approach to analyze 12,909 genomic sequences of SARS-CoV-2. The mutation rate is inferred to be 8.69 × 10(-4) per site per year with a 95% confidence interval (CI) of [8.61 × 10(-4), 8.77 × 10(-4)], and the TMRCA of the samples inferred to be Nov 28, 2019 with a 95% CI of [Oct 20, 2019, Dec 9, 2019]. The results indicate that COVID-19 might originate earlier than and outside of Wuhan Seafood Market. We further demonstrate that genetic polymorphism patterns, including the enrichment of specific haplotypes and the temporal allele frequency trajectories generated from infection clusters, are similar to those caused by evolutionary forces such as natural selection. Our results show that population genetic methods need to be developed to efficiently detangle the effects of sampling bias and infection clusters to gain insights into the evolutionary mechanism of SARS-CoV-2. Software for implementing VirusMuT can be downloaded at https://bigd.big.ac.cn/biocode/tools/BT007081.


title: Estimating the incidence reporting rates of new influenza pandemics at an early stage using travel data from the source country

text: During the surveillance of influenza pandemics, underreported data are a public health challenge that complicates the understanding of pandemic threats and can undermine mitigation efforts. We propose a method to estimate incidence reporting rates at early stages of new influenza pandemics using 2009 pandemic H1N1 as an example. Routine surveillance data and statistics of travellers arriving from Mexico were used. Our method incorporates changes in reporting rates such as linearly increasing trends due to the enhanced surveillance. From our results, the reporting rate was estimated at 0·46% during early stages of the pandemic in Mexico. We estimated cumulative incidence in the Mexican population to be 0·7% compared to 0·003% reported by officials in Mexico at the end of April. This method could be useful in estimation of actual cases during new influenza pandemics for policy makers to better determine appropriate control measures.


title: Research Ethics in the European Influenzanet Consortium: Scoping Review

text: BACKGROUND: Influenzanet was launched in several European countries to monitor influenza-like illness during flu seasons with the help of volunteering participants and Web-based technologies. As in the case of developing fields, ethical approaches are not well developed in the collection, processing, and analysis of participants’ information. Existing controversies and varying national ethical regulations can, thus, hamper efficient cross-border research collaboration to the detriment of quality disease surveillance. OBJECTIVE: This scoping review characterizes current practices on how ethical, legal, and social issues (ELSIs) pertinent to research ethics are handled by different Influenzanet country groups to analyze similarities and identify the need for further harmonization of ethical approaches. METHODS: A literature search was carried out on PubMed, Web of Science, Global Digital Library on Ethics, and Bioethics Literature Database to identify ELSIs for Influenzanet country platforms. Only English-language papers were included with publication dates from 2003 to 2017. Publications were screened for the application of bioethics principles in the implementation of country platforms. Additional publications gathered from the Influenzanet Consortium website, reference screening, and conference proceeding were screened for ELSIs. RESULTS: We gathered 96 papers from our search methodology. In total, 28 papers that mentioned ELSIs were identified and included in this study. The Research Ethics Committee (REC) approvals were sought for recruiting participants and collecting their data in 8 of 11 country platforms and informed e-consent was sought from participants in 9 of 11 country platforms. Furthermore, personal data protection was ensured throughout the Consortium using data anonymization before processing and analysis and using aggregated data. CONCLUSIONS: Epidemics forecasting activities, such as Influenzanet, are beneficial; however, its benefits could be further increased through the harmonization of data gathering and ethical requirements. This objective is achievable by the Consortium. More transparency should be promoted concerning REC-approved research for Influenzanet-like systems. The validity of informed e-consent could also be increased through the provision of a user friendly and standard information sheet across the Consortium where participants agree to its terms, conditions, and privacy policies before being able to fill in the questionnaire. This will help to build trust in the general public while preventing any decline in participation.


title: Ryzyko przeniesienia czynników zakaźnych przez transfuzje w Polsce

text: Blood transfusion in Poland is the safest in history. High virological level of safety has been achieved mainly by improving not only the qualification of donors and methods used for donor screening, but also applying leukoreduction, pathogen reduction technology and grace period for serum. In this article, we discuss the improvement of the epidemic situation among blood donors for hepatitis B virus (HBV) and hepatitis C virus (HCV) and the increasing trend for HIV. Preliminary results of residual risk calculation for these pathogens are presented. Hepatitis E virus (HEV) and Babesia microti were considered as new factors potentially relevant for the safety of blood transfusion in our country. Due to evidence of West Nile virus (WNV) circulation in the ecosystem in Poland, it is also necessary to monitor the infections with this pathogen. In this article, it was emphasized that the reporting of all possible complications associated with transfusion and meticulous implementation of the look-back procedure play a key role for monitoring the risk of transmission of infectious agents by blood. It is especially important in view of the increasing epidemiological problems associated with emerging infectious agents.


title: Severe virus influenza A H1N1 related pneumonia and community-acquired pneumonia: differences in the evolution

text: OBJECTIVE: To analyze the clinical, laboratory and evolution data of patients with severe influenza A H1N1 pneumonia and compare the data with that of patients with severe community-acquired bacterial pneumonia. METHODS: Cohort and retrospective study. All patients admitted to the intensive care unit between May 2009 and December 2010 with a diagnosis of severe pneumonia caused by the influenza A H1N1 virus were included in the study. Thirty patients with severe community-acquired pneumonia admitted within the same period were used as a control group. Severe community-acquired pneumonia was defined as the presence of at least one major severity criteria (ventilator or vasopressor use) or two minor criteria. RESULTS: The data of 45 patients were evaluated. Of these patients, 15 were infected with H1N1. When compared to the group with community-acquired pneumonia, patients from the H1N1 group had significantly lower leukocyte counts on admission (6,728±4,070 versus 16,038±7,863; p<0.05) and lower C-reactive protein levels (Day 2: 15.1±8.1 versus 22.1±10.9 mg/dL; p<0.05). The PaO(2)/FiO(2) ratio values were lower in the first week in patients with H1N1. Patients who did not survive the H1N1 severe pneumonia had significantly higher levels of C-reactive protein and higher serum creatinine levels compared with patients who survived. The mortality rate was significantly higher in the H1N1 group than in the control group (53% versus 20%; p=0.056, respectivelly). CONCLUSION: Differences in the leukocyte count, C-reactive protein concentrations and oxygenation profiles may contribute to the diagnosis and prognosis of patients with severe influenza A H1N1 virus-related pneumonia and community-acquired pneumonia.


title: Rapid detection and identification of 12 respiratory viruses using a dual priming oligonucleotide system-based multiplex PCR assay

text: Abstract Acute viral respiratory infections are among the most common causes of human disease. Rapid and accurate diagnosis of viral respiratory infections is important for providing timely therapeutic interventions. This study evaluated a new multiplex PCR assay (Seegene Inc., Seoul, Korea) for simultaneous detection and identification of 12 respiratory viruses using two primer mixes. The viruses included parainfluenza viruses 1, 2, and 3, human metapneumovirus, human coronavirus 229E/NL63 and OC43, adenovirus, influenza viruses A and B, human respiratory syncytial viruses A and B, and human rhinovirus A. The analytical sensitivity of the assay was 10–100 copies per reaction for each type of virus. There was no cross-reactivity with common bacterial or viral pathogens. A comparison with conventional viral culture and immunofluorescence was carried out using 101 respiratory specimens from 92 patients. Using viral culture, 57 specimens (56.4%) were positive without co-infection. The same viruses were identified in all 57 specimens using the multiplex PCR. Seven of the 57 specimens (12.3%) were found to be co-infected with other respiratory viruses, and 19 of 44 (43.2%) specimens which were negative by culture were positive by the multiplex PCR. The Seeplex Respiratory Virus Detection assay represents a significant improvement over the conventional methods for the detection of a broad spectrum of respiratory viruses.


title: Precision genetics for complex objectives in animal agriculture

text: Indirect modification of animal genomes by interspecific hybridization, cross-breeding, and selection has produced an enormous spectrum of phenotypic diversity over more than 10,000 yr of animal domestication. Using these established technologies, the farming community has successfully increased the yield and efficiency of production in most agricultural species while utilizing land resources that are often unsuitable for other agricultural purposes. Moving forward, animal well-being and agricultural sustainability are moral and economic priorities of consumers and producers alike. Therefore, these considerations will be included in any strategy designed to meet the challenges produced by global climate change and an expanding world population. Improvements in the efficiency and precision of genetic technologies will enable a timely response to meet the multifaceted food requirements of a rapidly increasing world population.


title: Clinicopathological characteristics of 8697 patients with COVID-19 in China: a meta-analysis

text: OBJECTIVE: Our study aims to present a summary of the clinicopathological characteristics of patients affected by the coronavirus disease 2019 (COVID-19) that can be used as a reference for further research and clinical decisions. DESIGN: Studies were included in the meta-analysis if they had cohort, case–control or case series designs and provided sufficient details on clinical symptoms, laboratory outcomes and asymptomatic patients. SETTING: PubMed, Embase, Chinese Biomedical Literature Database, Wanfang, China Science and Technology Journal Database and China National Knowledge Infrastructure databases were electronically searched to identify related studies published between 1 January 2020 and 16 March 2020. Three reviewers independently examined the literature, extracted relevant data and assessed the risk of publication bias before including the studies in the meta-analysis. PARTICIPANTS: The confirmed cases of COVID-19. RESULTS: A total of 55 unique retrospective studies involving 8697 patients with COVID-19 were identified. Meta-analysis showed that a higher proportion of infected patients were male (53.3%), and the two major symptoms observed were fever (78.4%) and cough (58.3%). Other common symptoms included fatigue (34%), myalgia (21.9%), expectoration (23.7%), anorexia (22.9%), chest tightness (22.9%) and dyspnoea (20.6%). Minor symptoms included nausea and vomiting (6.6%), diarrhoea (8.2%), headache (11.3%), pharyngalgia (11.6%), shivering (15.2%) and rhinorrhea (7.3%). About 5.4% of the patients were asymptomatic. Most patients showed normal leucocyte counts (64.7%) and elevated C reactive protein levels (65.9%). Lymphopaenia was observed in about 47.6% of the infected patients, along with abnormal levels of myocardial enzymes (49.4%) and liver function (26.4%). Other findings included leucopenia (23.5%), elevated D-dimer (20.4%), elevated erythrocyte sedimentation rate (20.4%), leucocytosis (9.9%), elevated procalcitonin (16.7%) and abnormal renal function (10.9%). CONCLUSIONS: The most commonly experienced symptoms of patients with COVID-19 were fever and cough. Myalgia, anorexia, chest tightness and dyspnoea were found in some patients. A relatively small percentage of patients were asymptomatic and could act as carriers of the disease. Most patients showed normal leucocyte counts, elevated levels of C reactive protein and lymphopaenia, confirming the viral origin of the disease.


title: COVID-19 and International Food Assistance: Policy Proposals to Keep Food Flowing

text: The COVID-19 pandemic is increasing the need for international food assistance, and disrupting the supply and delivery of food assistance. A series of unprecedented shocks is straining the capacity of food assistance organizations to reach vulnerable populations. We discuss how the COVID-19 pandemic is affecting the demand and the supply of international food assistance, and we propose three policy changes that can keep food flowing to those in need. First, donor countries can prioritize humanitarian spending in aid-allocation decisions. Second, governments can exempt food assistance from trade barriers that impede procurement (export restrictions) and delivery (import tariffs). Third, donor countries can allow flexibility for implementing agencies by untying food assistance from domestic procurement and shipping restrictions. All of these suggestions are regulatory changes that can be made without requiring increased spending. These options are particularly relevant now because donor-country governments are entering economic recessions, and foreign aid budgets will be constrained.


title: Pentraxin 3 deletion aggravates allergic inflammation through a TH17-dominant phenotype and enhanced CD4 T-cell survival

text: Background Pentraxin 3 (PTX3) is a multifunctional molecule that plays a nonredundant role at the crossroads between pathogen clearance, innate immune system, matrix deposition, female fertility, and vascular biology. It is produced at sites of infection and inflammation by both structural and inflammatory cells. However, its role in allergen-induced inflammation remains to be tested. Objective We sought to determine the effect of Ptx3 deletion on ovalbumin (OVA)–induced allergic inflammation in a murine model of asthma. Methods Bronchoalveolar lavage fluid was collected from patients with severe asthma and healthy subjects, and the level of PTX3 was determined by using ELISA. Ptx3 +/+ and Ptx3 −/− mice were sensitized and challenged with OVA and bronchoalveolar lavage fluid, and the lungs were collected for assessing inflammation. Lung tissue inflammation and mucus production were assessed by means of flow cytometry and hematoxylin and eosin and periodic acid-Schiff staining, respectively. flexiVent was used to determine airway resistance to methacholine in these mice. Results Here we report that mice with severe asthma and OVA-sensitized/challenged mice had increased PTX3 levels in the lungs compared with healthy control mice. Mice lacking PTX3 have exaggerated neutrophilic/eosinophilic lung inflammation, mucus production, and airway hyperresponsiveness in an experimental model of OVA-induced asthma. Furthermore, OVA-exposed lung Ptx3 −/− CD4 T cells exhibit an increased production of IL-17A, an effect that is accompanied by an increased signal transducer and activator of transcription 3 phosphorylation, reduced IL-2 production, and enhanced activation and survival. Also, we observed an increase in numbers of IL-6– and IL-23–producing dendritic cells in OVA-exposed Ptx3 −/− mice compared with those in wild-type control mice. Conclusion Altogether, PTX3 deficiency results in augmented airway hyperresponsiveness, mucus production, and IL-17A–dominant pulmonary inflammation, suggesting a regulatory role of PTX3 in the development of allergic inflammation.


title: Viral agents responsible for febrile respiratory illnesses among military recruits training in tropical Singapore

text: Abstract Background Military personnel are highly susceptible to febrile respiratory illnesses (FRI), likely due to crowding, stress and other risk factors present in the military environment. Objective Our objective was to investigate the viral etiological agents responsible for FRI among military recruits training in a tropical climate in Singapore. Study design From March 2006 through April 2007, a total of 1354 oropharyngeal (throat) swabs were collected from military recruits who reported sick with an oral temperature of ≥38°C and a cough and/or sore throat. Real-time polymerase chain reaction (PCR) was used to assay for the presence of influenza A and B viruses and adenoviruses (H-AdV), and conventional PCR used for the remaining respiratory viruses in all specimens. Results Influenza A virus was the dominant infection with a laboratory-confirmed incidence of 24% (326/1354) and a predominance of the H3N2 subtype. The temporal pattern for influenza A virus infections coincided with the nation-wide pattern in the civilian community. Detection rates of 12% (159/1354) and 2.7% (5/1354) were obtained for influenza B virus and other respiratory viruses, respectively. Conclusions The laboratory findings identified influenza A virus as the primary causative viral agent for FRI in the Singapore military, in strong contrast to findings from temperate countries and countries where recruits are often vaccinated for influenza. Our results suggest that influenza vaccination should be considered as a requirement to reduce the incidence of influenza infections. This is the first report describing respiratory infections in a tropical military setting, in a developed country in Asia.


Hand eczema ‐ a growing dermatological concern during the COVID‐19 pandemic and possible treatments


title: The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2

text: The present outbreak of a coronavirus-associated acute respiratory disease called coronavirus disease 19 (COVID-19) is the third documented spillover of an animal coronavirus to humans in only two decades that has resulted in a major epidemic. The Coronaviridae Study Group (CSG) of the International Committee on Taxonomy of Viruses, which is responsible for developing the classification of viruses and taxon nomenclature of the family Coronaviridae, has assessed the placement of the human pathogen, tentatively named 2019-nCoV, within the Coronaviridae. Based on phylogeny, taxonomy and established practice, the CSG recognizes this virus as forming a sister clade to the prototype human and bat severe acute respiratory syndrome coronaviruses (SARS-CoVs) of the species Severe acute respiratory syndrome-related coronavirus, and designates it as SARS-CoV-2. In order to facilitate communication, the CSG proposes to use the following naming convention for individual isolates: SARS-CoV-2/host/location/isolate/date. While the full spectrum of clinical manifestations associated with SARS-CoV-2 infections in humans remains to be determined, the independent zoonotic transmission of SARS-CoV and SARS-CoV-2 highlights the need for studying viruses at the species level to complement research focused on individual pathogenic viruses of immediate significance. This will improve our understanding of virus–host interactions in an ever-changing environment and enhance our preparedness for future outbreaks.


title: A Single-Cell Platform for Monitoring Viral Proteolytic Cleavage in Different Cellular Compartments

text: Infectious diseases affect human health despite advances in biomedical research and drug discovery. Among these, viruses are especially difficult to tackle due to the sudden transfer from animals to humans, high mutational rates, resistance to current treatments, and the intricacies of their molecular interactions with the host. As an example of these interactions, we describe a cell-based approach to monitor specific proteolytic events executed by either the viral-encoded protease or by host proteins on the virus. We then emphasize the significance of examining proteolysis within the subcellular compartment where cleavage occurs naturally. We show the power of stable expression, highlighting the usefulness of the cell-based multiplexed approach, which we have adapted to two independent assays previously developed to monitor (a) the activity of the HIV-1-encoded protease or (b) the cleavage of the HIV-1-encoded envelope protein by the host. Multiplexing was achieved by mixing cells each carrying a different assay or, alternatively, by engineering cells expressing two assays. Multiplexing relies on the robustness of the individual assays and their clear discrimination, further enhancing screening capabilities in an attempt to block proteolytic events required for viral infectivity and spread.


Toyama H, Li Y, Hatazawa J, Huang G, Kubota K (eds): PET/CT for inflammatory diseases: basic sciences, typical cases, and review: Singapore: Springer Nature Singapore Pte Ltd., 2020, 233 pages, Hardcover, 169.99 €


When a system breaks: queueing theory model of intensive care bed needs during the COVID‐19 pandemic


David Heymann—WHO's public health guru


title: Antiviral and Immunomodulatory Properties of Antimicrobial Peptides Produced by Human Keratinocytes

text: Keratinocytes, the main cells of the epidermis, are the first site of replication as well as the first line of defense against many viruses such as arboviruses, enteroviruses, herpes viruses, human papillomaviruses, or vaccinia virus. During viral replication, these cells can sense virus associated molecular patterns leading to the initiation of an innate immune response composed of pro-inflammatory cytokines, chemokines, and antimicrobial peptides. Human keratinocytes produce and secrete at least nine antimicrobial peptides: human cathelicidin LL-37, types 1–4 human β-defensins, S100 peptides such as psoriasin (S100A7), calprotectin (S100A8/9) and koebnerisin (S100A15), and RNase 7. These peptides can exert direct antiviral effects on the viral particle or its replication cycle, and indirect antiviral activity, by modulating the host immune response. The purpose of this review is to summarize current knowledge of antiviral and immunomodulatory properties of human keratinocyte antimicrobial peptides.


title: Rhinovirus infections in children: A retrospective and prospective hospital‐based study

text: To analyze clinical characteristics and prevalence of rhinovirus infections in children in the hospital, we reviewed a retrospective dataset from a 20‐year period, and conducted a short‐term prospective study. Records of children and adolescents treated at our hospital during 1987–2006 with a documented rhinovirus infection were reviewed and compared with patients with other respiratory virus infections. Prospective study included all children ≥1 month of age admitted to pediatric infectious disease ward during an autumn period. Rhinoviruses were detected by reverse transcription‐PCR and/or culture, and sequence analysis was used for virus typing. In the retrospective study, the median age of 580 children with rhinovirus infection was 1.9 years (interquartile range, 1.0–4.3 years), and 27% had an underlying medical condition. Eighty‐four children (16% of in‐patients) were treated at pediatric intensive care unit. Twenty‐one children (4%) had a hospital‐acquired rhinovirus infection. In the prospective study, rhinoviruses were detected in 28% of 163 hospital episodes. Acute wheezing illness was diagnosed in 61% of children with rhinovirus and in 31% of children with respiratory syncytial virus, enterovirus, or no study virus (P < 0.001). One‐half of sequence‐analyzed rhinovirus strains belonged to the newly identified C group. In conclusion, rhinovirus infections are a frequent cause of pediatric hospitalizations, and they are common also at the intensive care unit. Acute wheezing is the most frequent manifestation in hospital setting, but the range of clinical presentations is wide. Group C rhinoviruses may account for a large part of rhinovirus hospitalizations. J. Med. Virol. 81:1831–1838, 2009. © 2009 Wiley‐Liss, Inc.


title: What proportion of healthcare worker masks carry virus? A systematic review

text: BACKGROUND: Concerns have been raised by healthcare organisations in New Zealand that routine mask use by healthcare workers (HCW) may increase the risk of transmission of SARS‐CoV‐2 through increased face touching. Routine mask use by frontline HCW was not recommended when seeing ‘low risk’ patients. The aim of this review was to determine the carriage of respiratory viruses on facemasks used by HCW. METHODS: A systematic review was conducted with structured searches of medical and allied health databases. Two authors independently screened articles for inclusion, with substantial agreement (k=0.66, 95%CI 0.54 to 0.79). Studies that at least one author recommended for full text review were reviewed in full for inclusion. Two authors independently extracted data from included studies including the setting, method of analysis and results. There was exact agreement on the proportion of virus detected on masks. RESULTS: 1233 titles were retrieved, 47 underwent full text review and five studies reported in four articles were included. The studies were limited by small numbers and failure to test all eligible masks in some studies. The proportion in each study ranged from 0 (95% CI 0‐10) to 25% (95%CI 8‐54). No study reported clinical respiratory illness as a result of virus on the masks. CONCLUSIONS: Although limited, current evidence suggests that viral carriage on the outer surface of surgical masks worn by HCW treating patients with clinical respiratory illness is low and there was not strong evidence to support the assumption that mask use may increase the risk of viral transmission. This article is protected by copyright. All rights reserved.


title: A Clinical Perspective of Necrotizing Enterocolitis: Past, Present, and Future

text: Necrotizing enterocolitis (NEC) primarily affects premature infants. It is less common in term and late preterm infants. The age of onset is inversely related to the postmenstrual age at birth. In term infants, NEC is commonly associated with congenital heart diseases. NEC has also been associated with other anomalies. More than 85% of all NEC cases occur in very low birth weight infants or in very premature infants. Despite incremental advances in our understanding of the clinical presentation and pathophysiology of NEC, universal prevention of this disease continues to elude us even in the twenty-first century.


title: Psychological Functioning of Slovene Adults during the COVID-19 Pandemic: Does Resilience Matter?

text: As a public health emergency, a pandemic increases susceptibility to unfavourable psychological outcomes. The aim of the present study was to investigate the buffering role of personal resilience in two aspects of psychological functioning, mental health and stress, among Slovene adults at the beginning of the COVID-19 outbreak. Within five days after Slovenia declared epidemics, 2722 participants (75% female) completed an on-line survey measuring mental health and perceived stress as outcome variables and demographics, health-related variables, and personal resilience as predictor variables. Hierarchical logistic regression analyses demonstrated that women, younger, and less educated participants had higher odds for less favourable psychological functioning during the COVID-19 outbreak. In addition, poorer health indicators and COVID-19 infection concerns predicted diminished psychological functioning. The crucial factor promoting good psychological functioning during the COVID-19 pandemics was resilience, additionally buffering against detrimental effects of demographic and health-related variables on mental health and perceived stress. While previous research suggests that mental health problems increase during pandemics, one way to prevent these problems and bolster psychological functioning is to build individuals’ resilience. The interventions should be targeted particularly at younger adults, women, less educated people, and individuals who subjectively perceive their health to be rather poor.


title: Proportion of adult community-acquired pneumonia cases attributable to Streptococcus pneumoniae among Hajj pilgrims in 2016

text: Abstract Background The Hajj mass gathering is a risk for pneumococcal disease. This study was performed to evaluate the proportion of adult community-acquired pneumonia (CAP) cases attributable to Streptococcus pneumoniae among Hajj pilgrims in 2016. To add sensitivity to etiological attribution, a urine antigen test was used in addition to culture-based methods. Methods Adult subjects hospitalized with X-ray-confirmed CAP were enrolled prospectively from all general hospitals designated to treat Hajj pilgrims in the holy cities of Mecca and Medina. Patients were treated according to local standard of care and administered the BinaxNow S. pneumoniae urine antigen test. Results From August 23 to September 23, 2016, a total of 266 patients with CAP were enrolled in the study, 70.6% of whom were admitted to hospitals in Mecca; 53% of the cases were admitted after the peak of Hajj. Patients originated from 43 countries. Their mean age was 65.3 years and the male to female ratio was 2:1. Just over 36% of the cases had diabetes, 10% declared that they were smokers, and 45.4% of cases were treated in the intensive care unit (ICU). The overall case-fatality rate was 10.1%, but was higher among those treated in the ICU and in those with invasive disease. The proportion of CAP cases positive for S. pneumoniae, based on culture or urine antigen test, was 18.0% (95% confidence interval 13.9–23.1%). Conclusions CAP during Hajj has an important clinical impact. A proportion of CAP cases among Hajj pilgrims were attributable to S. pneumoniae, a pathogen for which vaccines are available. Additional studies to determine the serotypes causing pneumococcal disease could further inform vaccine policy for Hajj pilgrims.


title: Minimization of spreading of SARS-CoV-2 via household waste produced by subjects affected by COVID-19 or in quarantine

text: Abstract Currently available evidence supports that the predominant route of human-to-human transmission of the SARS-CoV-2 is through respiratory droplets. Indirect hands contact with surfaces contaminated by infectious droplets subsequently touching the mouth, nose or eyes seems to be another route of an indirect contact transmission. Persistence of the virus on different surfaces and other materials has been reported in recent studies: SARS-CoV-2 was more stable on plastic and stainless steel than on copper and cardboard. Viable virus was detected up to 72 h after application to different surfaces, although infectivity decay was also observed. This evidence suggests the likelihood that waste generated from patients affected by COVID-19 or subjects in quarantine treated in private houses or in areas different from hospitals and medical centres could be contaminated by SARS-CoV-2. Consequently, waste streams may represent a route for viral spreading being a potential risk also for the operators directly involved in the different phases of waste management. To address this concern, a specific multidisciplinary working group was settled by the Italian National Institute of Health (ISS) during the COVID-19 emergency, in order to establish guidelines related to solid waste collection, delivering, withdrawal, transport, treatment and disposal. Temporary stop of waste sorting, instructions for the population on how to package waste, instructions for Companies and operators for the adoption of adequate personal protection equipment (PPE), the use and sanitation of proper vehicles were among the main recommendations provided to the community by publications of freely downloadable reports and infographics in layman language. Incineration, sterilization and properly managed landfills were identified as the facilities to be preferentially adopted for the treatment of this kind of waste, considering the main inactivation strategies of SARS-CoV-2 (e.g. treatment length > 9 days and temperature > 70 °C for more than 5 min).


title: Viral diversity in swine intestinal mucus used for the manufacture of heparin as analyzed by high-throughput sequencing

text: Abstract Heparin is one of the main pharmaceutical products manufactured from raw animal material. In order to describe the viral burden associated with this raw material, we performed high-throughput sequencing (HTS) on mucus samples destined for heparin manufacturing, which were collected from European pigs. We identified Circoviridae and Parvoviridae members as the most prevalent contaminating viruses, together with viruses from the Picornaviridae, Astroviridae, Reoviridae, Caliciviridae, Adenoviridae, Birnaviridae, and Anelloviridae families. Putative new viral species were also identified. The load of several known or novel small non-enveloped viruses, which are particularly difficult to inactivate or eliminate during heparin processing, was quantified by qPCR. Analysis of the combined HTS and specific qPCR results will influence the refining and validation of inactivation procedures, as well as aiding in risk analysis of viral heparin contamination.


title: Combination of clinical symptoms and blood biomarkers can improve discrimination between bacterial or viral community-acquired pneumonia in children

text: BACKGROUND: Differentiating bacterial from viral pneumonia is important for guiding targeted management and judicious use of antibiotics. We assessed if clinical characteristics and blood inflammatory biomarkers could be used to distinguish bacterial from viral pneumonia. METHODS: Western Australian children (≤17 years) hospitalized with radiologically-confirmed community-acquired pneumonia were recruited and clinical symptoms and management data were collected. C-reactive protein (CRP), white cell counts (WCC) and absolute neutrophil counts (ANC) were measured as part of routine care. Clinical characteristics and biomarker levels were compared between cases with definite bacterial pneumonia (clinical empyema and/or bacteria detected in blood or pleural fluid), presumed viral pneumonia (presence of ≥1 virus in nasopharyngeal swab without criteria for definite bacterial pneumonia), and other pneumonia cases (pneumonia in the absence of criteria for either definite bacterial or presumed viral pneumonia). The area-under-curve (AUC) of the receiver operating characteristic (ROC) curve for varying biomarker levels were used to characterise their utility for discriminating definite bacterial from presumed viral pneumonia. For biomarkers with AUC > 0.8 (fair discriminator), Youden index was measured to determine the optimal cut-off threshold, and sensitivity, specificity, predictive values (positive and negative) were calculated. We investigated whether better discrimination could be achieved by combining biomarker values with the presence/absence of symptoms. RESULTS: From May 2015 to October 2017, 230 pneumonia cases were enrolled: 30 with definite bacterial pneumonia, 118 with presumed viral pneumonia and 82 other pneumonia cases. Differences in clinical signs and symptoms across the groups were noted; more definite bacterial pneumonia cases required intravenous fluid and oxygen supplementation than presumed viral or other pneumonia cases. CRP, WCC and ANC were substantially higher in definite bacterial cases. For a CRP threshold of 72 mg/L, the AUC of ROC was 0.82 for discriminating definite bacterial pneumonia from presumed viral pneumonia. Combining the CRP with either the presence of fever (≥38(ο)C) or the absence of rhinorrhea improved the discrimination. CONCLUSIONS: Combining elevated CRP with the presence or absence of clinical signs/ symptoms differentiates definite bacterial from presumed viral pneumonia better than CRP alone. Further studies are required to explore combination of biomarkers and symptoms for use as definitive diagnostic tool. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12890-019-0835-5) contains supplementary material, which is available to authorized users.


Subcutaneous terbutaline as an alternative to metered‐dose inhalers for asthma during the COVID‐19 pandemic


title: Amino acid substitution matrices from an information theoretic perspective

text: Abstract Protein sequence alignments have become an important tool for molecular biologists. Local alignments are frequently constructed with the aid of a “substitution score matrix” that specifies a score for aligning each pair of amino acid residues. Over the years, many different substitution matrices have been proposed, based on a wide variety of rationales. Statistical results, however, demonstrate that any such matrix is implicitly a “log-odds” matrix, with a specific target distribution for aligned pairs of amino acid residues. In the light of information theory, it is possible to express the scores of a substitution matrix in bits and to see that different matrices are better adapted to different purposes. The most widely used matrix for protein sequence comparison has been the PAM-250 matrix. It is argued that for database searches the PAM-120 matrix generally is more appropriate, while for comparing two specific proteins with suspected homology the PAM-200 matrix is indicated. Examples discussed include the lipocalins, human α 1B-glycoprotein, the cystic fibrosis transmembrane conductance regulator and the globins.


title: Rheumotologitsts’ view on the use of hydroxychloroquine to treat COVID-19

text: The current pandemic coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) calls urgently for effective therapies. Anti-malarial medicine chloroquine (CQ) and particularly its chemical analogue hydroxychloroquine (HCQ) have been recommended as promising candidate therapeutics that are now under either compassionate off-label use or clinical trials for the treatment of COVID-19 patients. However, there are public concerns and disputes about both the safety and efficacy of CQ and HCQ for this new application. Given the fact that for decades HCQ has been approved as an immunomodulatory drug for the long term treatment of chronic rheumatic diseases, as experienced rheumatologists, we would like to share our thoughts in this regard and trigger a brainstorm among clinical care providers for exchanging their diverse opinions on this urgent topic.


title: An investigation of the replication of coronaviruses in suspension cultures of L132 cells

text: A system is described for the study of the multiplication of two coronaviruses, both of human origin. Low efficiences of adsorption and infectious centre formation were observed. The viruses were found to have a 4–6 hour eclipse phase in L 132 cells at 33° C. Both viruses were completely inhibited by raising the incubation temperature to 39° C, and there was also a depression in the yield of virus at 30° C compared with control cultures maintained at 33° C. “Shift” experiments have indicated that the high temperature-sensitive event occurred fairly late on in the replicative cycle, but the time could not be accurately determined.


title: Complete genome analysis of Iranian IS-1494 like avian infectious bronchitis virus

text: The nephropathogenic infectious bronchitis virus (IBV) strain IS-1494 like (variant-2; GI-23) was first isolated in the Middle East (1998). Despite intensive vaccinations, IS-1494 like IBVs are still circulating in Iran (the dominant genotype) and spread to other countries. Here, the full-length genome of this Iranian IS-1494 like IBV was (Mahed) determined to understand its evolutionary relationships. The genome consists of 27,652 nucleotides, with mutations in most of the structural genes. Thirteen open reading frames (ORFs) were predicted in the Mahed isolate (5′ UTR-1a-1b-S-3a-3b-E-M-4b-4c-5a-5b-N-6b-3′ UTR). ORFs 4b, 4c, and 6b, which has rarely been reported, were present in the Mahed genome. According to phylogenetic analysis of the full-length genome, 1a, S2, M, E, N protein, Mahed isolate clustered with the QX type strain. Based on the partial 1b, S1, Mahed clustered with the Q1 strain. The full-length genome of Mahed isolate shared the highest sequence homology with Gray and JMK (90.06–90.07%) and was least related to the Vic-s (86.21%). These data show that evolutionary variation because of recombination in IBV plays a major role in the adaptation and origin of IBV leading to new genetic and types of the virus strain. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13337-018-0462-4) contains supplementary material, which is available to authorized users.


title: Spillover of SARS-CoV-2 into novel wild hosts in North America: A conceptual model for perpetuation of the pathogen

text: Abstract There is evidence that the current outbreak of the novel coronavirus SARS-CoV-2, which causes COVID-19, is of animal origin. As with a number of zoonotic pathogens, there is a risk of spillover into novel hosts. Here, we propose a hypothesized conceptual model that illustrates the mechanism whereby the SARS-CoV-2 could spillover from infected humans to naive wildlife hosts in North America. This proposed model is premised on transmission of SARS-CoV-2 from human feces through municipal waste water treatment plants into the natural aquatic environment where potential wildlife hosts become infected. We use the existing literature on human coronaviruses, including SARS CoV, to support the potential pathways and mechanisms in the conceptual model. Although we focus on North America, our conceptual model could apply to other parts of the globe as well.


Using Digital Data to Protect and Promote the Most Vulnerable in the Fight Against COVID-19


title: Development of tetraphenylethylene-based fluorescent oligosaccharide probes for detection of influenza virus

text: Abstract Tetraphenylethylene (TPE) derivatives have strong fluorescence in aggregated state. We designed and synthesized a tetraphenylethylene derivative bearing alkyne groups which were used for combination by click chemistry. The new TPE compound bearing alkyne groups was used to synthesize fluorescence oligosaccharide probes which have lactosyl and 6′-sialyllactosyl moieties as ligands. We found that the TPE compounds bearing lactosyl and 6′-sialyllactosyl moieties were useful for detection of RCA120 and SSA lectins, respectively. Moreover, we have shown that TPE-based fluorescent oligosaccharide probe bearing 6′-sialyllactose moiety can be utilized as a “turn-on” fluorescent sensor for detection of influenza virus.


title: Kawasaki disease shock syndrome or toxic shock syndrome in children and the relationship with COVID-19

text: Most pediatric patients with COVID-19 are asymptomatic or show only mild symptoms. However, in the last two months, first in Europe and recently in the United States, a small number of children have developed a more severe inflammatory syndrome associated with COVID-19, which often leads to hospitalization and sometimes requires intensive care A potential relationship was observed, especially between the occurrence of the Kawasaki disease and viral upper respiratory tract infections.


title: Airway Management in the Operating Room and Interventional Suites in Known or Suspected Coronavirus Disease 2019 Adult Patients: A Practical Review

text: Current evidence suggests that Coronavirus Disease 2019 (COVID-19) spread occurs via respiratory droplets (particles >5 µm) and possibly through aerosol. The rate of transmission remains high during airway management. This was evident during the 2003 severe acute respiratory syndrome epidemic where those who were involved in tracheal intubation had a higher risk of infection than those who were not involved (odds ratio 6.6). We describe specific airway management principles for patients with known or suspected COVID-19 disease for an array of critical care and procedural settings. We conducted a thorough search of the available literature of airway management of COVID-19 across a variety of international settings. In addition, we have analyzed various medical professional body recommendations for common procedural practices such as interventional cardiology, gastroenterology, and pulmonology. A systematic process that aims to protect the operators involved via appropriate personal protective equipment, avoidance of unnecessary patient contact and minimalization of periprocedural aerosol generation are key components to successful airway management. For operating room cases requiring general anesthesia or complex interventional procedures, tracheal intubation should be the preferred option. For interventional procedures, when tracheal intubation is not indicated, cautious conscious sedation appears to be a reasonable approach. Awake intubation should be avoided unless it is absolutely necessary. Extubation is a high-risk procedure for aerosol and droplet spread and needs thorough planning and preparation. As updates and modifications in the management of COVID-19 are still evolving, local guidelines, appraised at regular intervals, are vital in optimizing clinical management.


title: COVID-19: Peer Support and Crisis Communication Strategies to Promote Institutional Resilience

text: Caring for patients with the novel coronavirus infection is placing great stress on health care systems and health care workers. On the basis of their experiences responding to other pandemics, the authors summarize lessons learned and offer some best practices for facilitating organizational resilience and supporting health care workers during the COVID-19 pandemic.


title: Private hospital expansion in China: a global perspective

text: Abstract Objective: To assess the private hospital development in China during 2005-2016 from a global perspective. Methods: We searched the English and Chinese literature in PubMed, CNKI and Google Scholar databases with the keywords including “private hospitals in China”, “hospital ownership”, “public and private hospital”, “private hospital development”. Descriptive statistical analysis was used to assess the trend of the private hospital development in China and worldwide. Both the change of private hospitals in supply capacity and health care delivery were studied in this paper. The number of hospitals, number of hospital beds and the average number of hospital beds per hospital were employed to measure the supply capacity. The visit number, inpatients number, and bed occupancy rate (BOR) were used to measure the healthcare delivery. The data was collected from the China Health Statistical Yearbook and the “Organisation for Economic and Co-operation and Development (OECD) Statistics” website. Results: The private sector rapidly expanded in China’s hospital market in recent years. The number of private hospitals exceeded the public in 2015. There has also been a significant rise for the indicators of both the supply capacity (including number of hospitals, number of hospital beds and the average number of hospital beds per hospital) and the health care delivery (inpatients number and BOR) of the private hospitals. However, the growth rates of them were relatively lower than the public. The expansion trend of China’s private sector in the hospital market accorded with most the OECD countries around the world. In 2016, China was above the medium level of the share of the private hospitals’ number with the OECD countries, but below the medium for the supply capacity, in terms of the hospital beds. Conclusion: As a result of the economic growth and supporting policy, the private sector has experienced a vast expansion in China’s hospital market in the past decade. The rising gap in average size between private and publicly owned hospitals, and the inconsistent development between the private hospitals’ supply capacity and their market share, have become the two main challenges. Meanwhile, the future policy in supporting the private sector should be carefully introduced to advance the whole healthcare delivery system development in China.


title: Effects of Ambient Temperature and Humidity on Droplet Lifetime – A Perspective of Exhalation Sneeze Droplets with COVID-19 Virus Transmission

text: A one-dimensional droplet evaporation model is used to estimate the droplet lifetime from evaporation in air. The mathematical model invokes assumptions of spherical symmetry, ideal gas mixture, binary diffusion, no re-condensation on droplet surface, and constant properties. Four initial droplet diameters (0.001, 0.01, 0.1, and 1 mm), two ambient temperatures (20 and 30 C) and a range of ambient relative humidity are considered. For the conditions studied, the results show that the ambient relative humidity plays an important role in the droplet lifetime calculation. Increasing the ambient temperature does not necessarily decrease the droplet lifetime; it occurs only when the ambient relative humidity is set below 37%. When the ambient relative humidity is higher than 37%, the higher ambient temperature (30 C) results in a longer droplet lifetime for the same initial droplet diameter considered. The results also suggest that there may exist a critical ambient relative humidity; beyond which, the droplet lifetime will increase exponentially. For ambient temperature at 30 C, the critical ambient relative humidity is around 55.7%. It must be mentioned that the results of this study do not imply that the COVID-19 virus will be deactivated at the end of the droplet lifetime. The study simply shows the potential effects resulting from the ambient temperature and ambient relative humidity on virus carrying drops.


title: Angiotensin converting enzyme 2 abrogates bleomycin-induced lung injury

text: Despite substantial progress, mortality and morbidity of the acute respiratory distress syndrome (ARDS), a severe form of acute lung injury (ALI), remain unacceptably high. There is no effective treatment for ARDS/ALI. The renin–angiotensin system (RAS) through Angiotensin-converting enzyme (ACE)-generated Angiotensin II contributes to lung injury. ACE2, a recently discovered ACE homologue, acts as a negative regulator of the RAS and counterbalances the function of ACE. We hypothesized that ACE2 prevents Bleomycin (BLM)-induced lung injury. Fourteen to 16-week-old ACE2 knockout mice—male (ACE2(−/y)) and female (ACE2(−/−))—and age-matched wild-type (WT) male mice received intratracheal BLM (1.5U/kg). Male ACE2(−/y) BLM injured mice exhibited poorer exercise capacity, worse lung function and exacerbated lung fibrosis and collagen deposition compared with WT. These changes were associated with increased expression of the profibrotic genes α-smooth muscle actin (α-SMA) and Transforming Growth Factor ß1. Compared with ACE2(−/y) exposed to BLM, ACE2(−/−) exhibited better lung function and architecture and decreased collagen deposition. Treatment with intraperitoneal recombinant human (rh) ACE2 (2 mg/kg) for 21 days improved survival, exercise capacity, and lung function and decreased lung inflammation and fibrosis in male BLM-WT mice. Female BLM WT mice had mild fibrosis and displayed a possible compensatory upregulation of the AT2 receptor. We conclude that ACE2 gene deletion worsens BLM-induced lung injury and more so in males than females. Conversely, ACE2 protects against BLM-induced fibrosis. rhACE2 may have therapeutic potential to attenuate respiratory morbidity in ALI/ARDS.


title: Pre-structured hydrophobic peptide β-strands: A universal amyloid trap?

text: Abstract Amyloid fibril formation has long been studied because of the variety of proteins that are capable of adopting this structure despite sharing little sequence homology. This makes amyloid fibrils a challenging focus for inhibition studies because the peptides and proteins that form amyloid fibrils cannot be targeted based on a sequence motif. Most peptide inhibitors that target specific amyloidogenic proteins rely heavily on sequence recognition to ensure that the inhibitory peptide is able to bind its target. This approach is limited to targeting one amyloidogenic protein at a time. However, there is increasing evidence of cross-reactivity between amyloid-forming polypeptides. It has therefore become more useful to study the similarities between these proteins that goes beyond their sequence homology. Indeed, the observation that amyloidogenic proteins adopt similar secondary structures along the pathway to fibril formation opens the way to an interesting investigation: the development of inhibitors that could be universal amyloid traps. The review below will analyze two specific amyloidogenic proteins, α-synuclein and human amylin, and introduce a small number of peptides that have been shown to be capable of inhibiting the amyloidogenesis of both of these very dissimilar polypeptides. Some of the inhibitory peptide motifs may indeed, be applicable to Aβ and other amyloidogenic systems.


title: Transmission Pathways of Foot-and-Mouth Disease Virus in the United Kingdom in 2007

text: Foot-and-mouth disease (FMD) virus causes an acute vesicular disease of domesticated and wild ruminants and pigs. Identifying sources of FMD outbreaks is often confounded by incomplete epidemiological evidence and the numerous routes by which virus can spread (movements of infected animals or their products, contaminated persons, objects, and aerosols). Here, we show that the outbreaks of FMD in the United Kingdom in August 2007 were caused by a derivative of FMDV O(1) BFS 1860, a virus strain handled at two FMD laboratories located on a single site at Pirbright in Surrey. Genetic analysis of complete viral genomes generated in real-time reveals a probable chain of transmission events, predicting undisclosed infected premises, and connecting the second cluster of outbreaks in September to those in August. Complete genome sequence analysis of FMD viruses conducted in real-time have identified the initial and intermediate sources of these outbreaks and demonstrate the value of such techniques in providing information useful to contemporary disease control programmes.


title: Prevalence of serum neutralizing antibodies to adenovirus type 5 (Ad5) and 41 (Ad41) in children is associated with age and sanitary conditions

text: Abstract Neutralizing antibody (NAb) can dampen the immunogenicity of adenovirus (Ad) vector-based vaccine. Vector systems based on human adenovirus type 41 (Ad41) have been constructed and used to develop recombinant vaccines. Here, we attempted to study the seroprevalence of NAbs to Ad5 and Ad41 among children and adults in Qinghai province, China. The positive rates (titer⩾40) of Ad5 and Ad41 NAb in adults from Xining city were 75.7% and 94.7%, respectively. The moderate/high-positive rates (titer⩾160) of NAb were quite close between the two viruses in adults (70.4% for Ad5 and 73.5% for Ad41). Age-dependent increase of NAb seroprevalence was observed for both viruses in children. NAb-positive rate of Ad41 reached 50% at 3.3–4.6years of age for children from Chengxi district, Xining city, approximately 1.5years earlier than that of Ad5 did. Interestingly, NAb level was also associated with sanitary conditions among young children. For Ad5, 8–15% children (0.2–3.0years of age) from city or town, where the sanitations were relatively better, had moderate/high-positive NAb, while the same rate was 62% for children from villages. For Ad41, 22% children from city, 47% from town and 88% from villages possessed moderate/high-positive NAb. The possible influence of NAb titer distributions on the application of Ad41-vectored vaccines was discussed in detail. Our results suggested that children from places with poor sanitations should be included for comprehensive Ad NAb seroprevalence studies, and provided insights to the applications of Ad41 vectors.


title: What healthcare professionals owe us: why their duty to treat during a pandemic is contingent on personal protective equipment (PPE)

text: Healthcare professionals’ capacity to protect themselves, while caring for infected patients during an infectious disease pandemic, depends on their ability to practise universal precautions. In turn, universal precautions rely on the availability of personal protective equipment (PPE). During the SARS-CoV2 outbreak many healthcare workers across the globe have been reluctant to provide patient care because crucial PPE components are in short supply. The lack of such equipment during the pandemic was not a result of careful resource allocation decisions in the global north, where the short supply could be explained through their high cost. Instead, they were the result of democratically elected governments prioritising low tax regimes over an adequate resourcing of their healthcare delivery systems. Such decisions were made despite global health experts warning about the high probability of pandemics like SARS-CoV2 occurring during our lifetimes. Avoidable allocation decisions by democratically elected political leaders resulted in a lack of sufficient PPE for healthcare professionals. After discussing and discounting various ethical arguments in support of a professional obligation to treat, even without or with suboptimal PPE, I conclude that these policy decisions were sufficiently grave that they provide a sound ethical rationale to justify healthcare workers’ refusal to provide care to infected patients.


title: Medical applications of infrared thermography: A review

text: Abstract Abnormal body temperature is a natural indicator of illness. Infrared thermography (IRT) is a fast, passive, non-contact and non-invasive alternative to conventional clinical thermometers for monitoring body temperature. Besides, IRT can also map body surface temperature remotely. Last five decades witnessed a steady increase in the utility of thermal imaging cameras to obtain correlations between the thermal physiology and skin temperature. IRT has been successfully used in diagnosis of breast cancer, diabetes neuropathy and peripheral vascular disorders. It has also been used to detect problems associated with gynecology, kidney transplantation, dermatology, heart, neonatal physiology, fever screening and brain imaging. With the advent of modern infrared cameras, data acquisition and processing techniques, it is now possible to have real time high resolution thermographic images, which is likely to surge further research in this field. The present efforts are focused on automatic analysis of temperature distribution of regions of interest and their statistical analysis for detection of abnormalities. This critical review focuses on advances in the area of medical IRT. The basics of IRT, essential theoretical background, the procedures adopted for various measurements and applications of IRT in various medical fields are discussed in this review. Besides background information is provided for beginners for better understanding of the subject.


title: Scales of governance: The role of surveillance in facilitating new diplomacy during the 2009–2010 H1N1 pandemic

text: Abstract The 2009–2010 H1N1 influenza pandemic has highlighted the importance of global health surveillance. Increasingly, global alerts are based on 'unexpected’ 'events’ detected by surveillance systems grounded in particular places. An emerging global governance literature investigates the supposedly disruptive impact of public health emergencies on mobilities in an interdependent world. Little consideration has been given to the varied scales of governance – local, national and global – that operate at different stages in the unfolding of an 'event', together with the interactions and tensions between them. By tracking the chronology of the H1N1 pandemic, this paper highlights an emergent dialogue between local and global scales. It also draws attention to moments of national autonomy across the global North and South which undermined the WHO drive for transnational cooperation.


title: New strategic market segment and follow-on orders continue to strengthen Aspiral's position in China

text: As reported previously in this newsletter, Fluence Corp Ltd's Aspiral™ family of decentralised, smart packaged wastewater treatment systems is being used worldwide, including countries such as China, where it is already being employed in numerous applications. Here, we briefly look at some recent developments in this country, where interest in this technology continues to grow. As an aside, the company has also provided an update regarding its operations in China and how they are potentially affected by the outbreak of the coronavirus.


title: Immunity to transmissible gastroenteritis virus and porcine respiratory coronavirus infections in swine

text: Abstract Despite the pioneering efforts to identify correlates of passive immunity to transmissible gastroenteritis virus (TGEV), effective vaccines for the control of TGE in suckling pigs have remained elusive. The initial concept of an enteromammary immunologic axis in monogastrics originated from studies of lactogenic immunity to TGEV in swine. These studies revealed that infection of pregnant swine with virulent TGEV stimulated high titers of SIgA antibodies in milk which correlated with protection of suckling pigs against TGE; parenteral or oral inoculation with live attenuated or killed TGEV vaccines induced mainly IgG antibodies in milk which generally provided poor protection to suckling pigs. The recent appearance of PRCV infections in swine and continuing studies of TGEV infections, present a unique model for further studies of mucosal immunity. Research using these viruses has increased our understanding of the various components of the common mucosal immune system and their interactions. Although the most important consideration in designing an effective vaccine for TGEV is the stimulation of GALT through intestinal virus replication, studies addressing the contribution of BALT to immunity to TGEV and PRCV may provide insights for alternative vaccine approaches. The mechanism by which exposure to PRCV elicits a variable degree of immunity to TGEV challenge is unknown. Virus replication in the gut or respiratory tract is a major factor affecting the magnitude of the immune response at the respective site and may be necessary for the recruitment of specific immune cells from other mucosal inductive sites, i.e., GALT to BALT and BALT to GALT migration. Further studies on the induction and immune regulation of specific responses to TGEV and PRCV that affect the distribution patterns of IgM-, IgG- and IgA-antibody-secreting cells (ASC) and T lymphocytes should provide valuable insights for optimizing vaccine regimens to elicit the highest mucosal immune responses and optimal protection against TGEV challenge.


title: Coronavirus disease 2019 (COVID-19) in children: a systematic review of imaging findings

text: BACKGROUND: COVID-19 is a novel coronavirus infection that can cause a severe respiratory illness and has been declared a pandemic by the World Health Organization (WHO). Because children appear to be less severely affected than adults, their imaging appearances have not been extensively reported. OBJECTIVE: To systematically review available literature regarding imaging findings in paediatric cases of COVID-19. MATERIALS AND METHODS: We searched four databases (Medline, Embase, Cochrane, Google Scholar) for articles describing imaging findings in children with COVID-19. We included all modalities, age <18 years, and foreign language articles, using descriptive statistics to identify patterns and locations of imaging findings, and their association with outcomes. RESULTS: Twenty-two articles were included, reporting chest imaging findings in 431 children, of whom 421 (97.7%) underwent CT. Criteria for imaging were lacking. At diagnosis, 143/421 (34.0%) had a normal CT. Abnormalities were more common in the lower lobes and were predominantly unilateral. The most common imaging pattern was ground-glass opacification (159/255, 62.4%). None of the studies described lymphadenopathy, while pleural effusions were rare (three cases). Improvement at follow-up CT imaging (3–15 days later) was seen in 29/100 (29%), remained normal in 25/100 (25%) and progressed in 9/100 (9%). CONCLUSION: CT chest findings in children with COVID-19 are frequently normal or mild. Lower lobes are predominantly affected by patchy ground-glass opacification. Appearances at follow-up remain normal or improve in the majority of children. Chest CT imaging adds little to the further management of the patient and should be reserved for severe cases or for identifying alternative diagnoses. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00247-020-04726-w) contains supplementary material, which is available to authorized users.


Early appearance of COVID-19 associated pulmonary infiltrates during daily radiotherapy imaging for lung cancer.


title: Neotropical Bats from Costa Rica harbour Diverse Coronaviruses

text: Bats are hosts of diverse coronaviruses (CoVs) known to potentially cross the host–species barrier. For analysing coronavirus diversity in a bat species‐rich country, a total of 421 anal swabs/faecal samples from Costa Rican bats were screened for CoV RNA‐dependent RNA polymerase (RdRp) gene sequences by a pancoronavirus PCR. Six families, 24 genera and 41 species of bats were analysed. The detection rate for CoV was 1%. Individuals (n = 4) from four different species of frugivorous (Artibeus jamaicensis, Carollia perspicillata and Carollia castanea) and nectivorous (Glossophaga soricina) bats were positive for coronavirus‐derived nucleic acids. Analysis of 440 nt. RdRp sequences allocated all Costa Rican bat CoVs to the α‐CoV group. Several CoVs sequences clustered near previously described CoVs from the same species of bat, but were phylogenetically distant from the human CoV sequences identified to date, suggesting no recent spillover events. The Glossophaga soricina CoV sequence is sufficiently dissimilar (26% homology to the closest known bat CoVs) to represent a unique coronavirus not clustering near other CoVs found in the same bat species so far, implying an even higher CoV diversity than previously suspected.


title: SARS-CoV-2 in sewer systems and connected facilities

text: As for the SARS coronavirus in the 2003 epidemic, the presence of SARS-CoV-2 has been demonstrated in faeces and, in some cases, urine of infected people, as well as in wastewater. This paper proposes a critical review of the state of the art regarding studies on the presence of SARS-CoV-2 in wastewater and sewage sludge, the factors affecting its inactivation and the main proposed treatments. In-vitro tests demonstrated low resistance of SARS-CoV-2 to high temperature, while even significant changes in pH would not seem to determine the disappearance of the virus. In wastewater and in sewage sludge, to date studies on the influence of the different parameters on the inactivation of SARS-CoV-2 in real matrices are not available. Therefore, studies involving other HCoVs such as SARS-CoV and HCoV-229E have been also considered, in order to formulate a hypothesis regarding its behaviour in sewage and throughout the steps of biological treatments in WWTPs. Finally, SARS-CoV-2 in wastewater might track the epidemic trends: although being extremely promising, an effective and wide application of this approach requires a deeper knowledge of the amounts of viruses excreted through the faeces and the actual detectability of viral RNA in sewage.


Abdominal and testicular pain: An atypical presentation of COVID-19


Eye care in the intensive care unit during the COVID‐19 pandemic and beyond


title: Cilia‐related diseases

text: There are at least eight categories of cilia in the human body and malfunctioning of any one or several of them will have different consequences for the patient. A genetic error of the respiratory cilia (9 + 2) is the cause of the airways disease named immotile‐cilia syndrome (or PCD), whereas defective ependymal cilia (9 + 2) carries an increased risk of hydrocephalus. When the so‐called nodal cilia (9 + 0) of the early embryo are malfunctioning, there is a random determination of asymmetry of the heart and visceral organs (‘a 50% risk of situs inversus’). Some genes are responsible for the synthesis, transport, and assembly of the cilia, and mutations in these genes may lead to progressive degeneration of ciliary structures, such as the connecting cilium (9 + 0) of the photoreceptor cells—this is the cause of retinitis pigmentosa. Ciliary malfunctions due to genetic errors tend to be systemic and life‐long, whereas acquired diseases are local and may be temporary only. Copyright © 2004 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.


title: Chapter 15 Viral surface glycoproteins in carbohydrate recognition Structure and modelling

text: Publisher Summary A large number of clinically important viruses utilize carbohydrate viral surface protein interactions to propagate infection and disease. The identification and structural characterization of the proteins and glycans essential in these recognition phenomena opens up new avenues for both drug discovery and vaccine development. This chapter describes some of the most significant developments in the field of structure-based investigations of viral surface-resident carbohydrate-recognizing proteins. Specifically, an overview of these carbohydrate-recognizing proteins from four important human viruses, including influenza, dengue, rotavirus, parainfluenza, and associated structural investigations will be presented. The surface of flavivirus is predominantly covered by E-glycoprotein (EGP) that forms dimers tethered to the surface by a stalk region. The EGP-associated glycan of the virus has been shown to be important for Dengue virus infection. Both human parainfluenza viruses and Newcastle disease virus have a surface-resident carbohydrate recognizing protein known as hemagglutinin-neuramindase (HN), which is involved in both cellular recognition and as a receptor-destroying enzyme. Influenza virus neuraminidase (NA) is a glycosylated homo-tetramer that is tethered to the virus surface by a long protein stalk at its C terminal.


title: Tracking COVID-19 in Europe: Infodemiology Approach

text: BACKGROUND: Infodemiology (ie, information epidemiology) uses web-based data to inform public health and policy. Infodemiology metrics have been widely and successfully used to assess and forecast epidemics and outbreaks. OBJECTIVE: In light of the recent coronavirus disease (COVID-19) pandemic that started in Wuhan, China in 2019, online search traffic data from Google are used to track the spread of the new coronavirus disease in Europe. METHODS: Time series from Google Trends from January to March 2020 on the Topic (Virus) of “Coronavirus” were retrieved and correlated with official data on COVID-19 cases and deaths worldwide and in the European countries that have been affected the most: Italy (at national and regional level), Spain, France, Germany, and the United Kingdom. RESULTS: Statistically significant correlations are observed between online interest and COVID-19 cases and deaths. Furthermore, a critical point, after which the Pearson correlation coefficient starts declining (even if it is still statistically significant) was identified, indicating that this method is most efficient in regions or countries that have not yet peaked in COVID-19 cases. CONCLUSIONS: In the past, infodemiology metrics in general and data from Google Trends in particular have been shown to be useful in tracking and forecasting outbreaks, epidemics, and pandemics as, for example, in the cases of the Middle East respiratory syndrome, Ebola, measles, and Zika. With the COVID-19 pandemic still in the beginning stages, it is essential to explore and combine new methods of disease surveillance to assist with the preparedness of health care systems at the regional level.


title: Increased Mortality Rate Associated with Chikungunya Epidemic, Ahmedabad, India

text: A total of 3,056 excess deaths epidemiologically linked to chikungunya occurred in 2006.


title: Prehabilitation Telemedicine in Neoadjuvant Surgical Oncology Patients During the Novel COVID-19 Coronavirus Pandemic

text: Supplemental Digital Content is available in the text