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BACKGROUND: The clinical characteristics of human metapneumovirus (hMPV)-associated lower respiratory tract infection (LRTI) after allogeneic hematopoietic stem cell transplantation (HSCT) is not well described. We describe the clinical course in eight HSCT recipients suffering from hMPV infection. METHODS: We prospectively included all patients with hMPV-associated LRTI after allogeneic HSCT during a period of 1 year. hMPV was diagnosed by multiplex polymerase chain reaction (PCR) from bronchoalveolar lavage (BAL). RESULTS: Eight patients with hMPV-associated LRTI were identified from 93 BAL samples. Three of the eight patients had co-infections with other pathogens. The median age of the patients was 45 years [interquartile range (IQR) 36.8–53.5], the median time posttransplant was 473 days (IQR 251–1,165), 5/8 patients had chronic graft-versus-host disease (cGvHD), and 6/8 patients received immunosuppression. Chest computed tomography (CT) scanning showed a ground-glass pattern in 7/8 patients. Seven of eight patients required hospitalization due to severe symptoms and hypoxemia. All were treated with intravenous immunoglobulin (IVIG), which was combined with oral ribavirin in six patients. The mortality rate was 12.5 % (1/8). CONCLUSIONS: hMPV-associated LRTI in allogeneic HSCT recipients are not uncommon and present with unspecific respiratory symptoms, ground-glass pattern in CT scanning, and co-infection.

Human metapneumovirus infection after allogeneic hematopoietic stem cell transplantation

Reacting to public health threats as early as possible is crucial in preventing harm from large population groups. Surveillance systems support the management and early detection of disease activity. Besides traditional systems that rely on reported diagnoses from laboratories, electronic media and discussion groups are increasingly recognized as valuable sources of public health alerts. Beyond, crisis communication increasingly relies upon online communication for exchanging information and opinions on a crisis and for supporting the coordination of resources including equipment, personnel, and information during a crisis situation. This chapter gives an overview on social media tools and data sources and their content with respect to a use in disease surveillance and health crisis management. We further provide an overview on approaches to disease surveillance using the Web and analyze their strengths and weaknesses. Ethical and legal aspects to be considered during implementation of web-based disease surveillance will be presented.

Social Media and Health Crisis Communication During Epidemics

Every day there are 10,000 scientific articles published. Since the Consultation-Liaison ("C-L") psychiatrist may be asked to consult on a patient with any medical illness, e.g., severe acute respiratory syndrome (SARS), malaria, cancer, stroke, amytrophic, lateral sclerosis, and a patient who may be on any medical drug, methods need to be developed to review the recent literature and have an awareness of key and essential current findings. At the same time, teachers need to develop a current listing of seminal papers for trainees and practitioners of this newest cross-over subspecialty of psychiatry-now called Psychosomatic Medicine. Experts selected because of their writings and acknowledged contributions to a specific clinical area or problem hope examined thousands of citations to choose those articles, chapters, books, or letters that they regard as most important to Psychosomatic Medicine. In addition, psychiatric specialists in six countries have provided their national Psychosomatic Medicine (Consultation-Liaison) lists as examples of what they regard as the most important teaching materials journals: Australia, Brazil, Greece, Mexico, Portugal, and Taiwan. It is our belief that a cogent, international, systematic review will provide the greatest success in creating a "regionally appropriate" teaching and consultation literature database with world-wide applicability. We review our current progress on this literature database and software, the technical system and data organization involved, the approach used to populate the literature system, and ongoing development plans to bring this system to the physician via mobile technologies.

Consultation-Liaison Psychiatry Literature Database (2003 update). Part I: Consultation - Liaison Literature Database: 2003 update and national lists.

Several medications commonly used for a number of medical conditions share a property of functional inhibition of acid sphingomyelinase (ASM), or FIASMA. Preclinical and clinical evidence suggest that the (ASM)/ceramide system may be central to SARS‐CoV‐2 infection. We examined the potential usefulness of FIASMA use among patients hospitalized for severe COVID‐19 in an observational multicenter study conducted at Greater Paris University hospitals. Of 2,846 adult patients hospitalized for severe COVID‐19, 277 (9.7%) were taking a FIASMA medication at the time of their hospital admission. The primary endpoint was a composite of intubation and/or death. We compared this endpoint between patients taking vs. not taking a FIASMA medication in time‐to‐event analyses adjusted for sociodemographic characteristics and medical comorbidities. The primary analysis was a Cox regression model with inverse probability weighting (IPW). Over a mean follow‐up of 9.2 days (SD=12.5), the primary endpoint occurred in 104 patients (37.5%) receiving a FIASMA medication, and 1,060 patients (41.4%) who did not. Despite being significantly and substantially associated with older age and greater medical severity, FIASMA medication use was significantly associated with reduced likelihood of intubation or death in both crude (HR=0.71; 95%CI=0.58‐0.87; p<0.001) and primary IPW (HR=0.58; 95%CI=0.46‐0.72; p<0.001) analyses. This association remained significant in multiple sensitivity analyses and was not specific to one particular FIASMA class or medication. These results show the potential importance of the ASM/ceramide system in COVID‐19 and support the continuation of FIASMA medications in these patients. Double‐blind controlled randomized clinical trials of these medications for COVID‐19 are needed.

Association between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for Severe COVID‐19: an observational multicenter study

The coronavirus disease 2019 (COVID‐19) pandemic demonstrates the importance of generating safe and efficacious vaccines that can be rapidly deployed against emerging pathogens. Subunit vaccines are considered among the safest, but proteins used in these typically lack strong immunogenicity, leading to poor immune responses. Here, a biomaterial COVID‐19 vaccine based on a mesoporous silica rods (MSRs) platform is described. MSRs loaded with granulocyte‐macrophage colony‐stimulating factor (GM‐CSF), the toll‐like receptor 4 (TLR‐4) agonist monophosphoryl lipid A (MPLA), and SARS‐CoV‐2 viral protein antigens slowly release their cargo and form subcutaneous scaffolds that locally recruit and activate antigen‐presenting cells (APCs) for the generation of adaptive immunity. MSR‐based vaccines generate robust and durable cellular and humoral responses against SARS‐CoV‐2 antigens, including the poorly immunogenic receptor binding domain (RBD) of the spike (S) protein. Persistent antibodies over the course of 8 months are found in all vaccine configurations tested and robust in vitro viral neutralization is observed both in a prime‐boost and a single‐dose regimen. These vaccines can be fully formulated ahead of time or stored lyophilized and reconstituted with an antigen mixture moments before injection, which can facilitate its rapid deployment against emerging SARS‐CoV‐2 variants or new pathogens. Together, the data show a promising COVID‐19 vaccine candidate and a generally adaptable vaccine platform against infectious pathogens.

A Modular Biomaterial Scaffold‐Based Vaccine Elicits Durable Adaptive Immunity to Subunit SARS‐CoV‐2 Antigens

BACKGROUND: Serious conditions caused by the coronavirus epidemic are expected to affect the mental and physical health, organizational and social commitments of healthcare workers. Therefore, this study aimed to evaluate the organizational and social commitments and related factors during the coronavirus pandemic of healthcare workers in northern Iran. METHODS: This descriptive-analytical study was conducted in 2020 among 260 healthcare workers of Babol health centers by a stratified-random sampling method. Data were collected according to a valid and reliable questionnaire consisting of three parts: 8 questions about personal and job characteristics, 15 questions from Porter Organizational Commitment Questionnaire (OCQ), 15 questions from Carroll’s social responsibility. Each question was scored on the Likert scale of organizational and social commitment questionnaires. Data were analyzed by chi-square and logistic regression. P < 0.05 was considered as statistically significant. RESULTS: None of the healthcare workers belonged to the category of low organizational commitments. A portion of 27.7% of the healthcare workers had moderate organizational commitments and 72.3% had high organizational commitments. A portion of 9.2% of the healthcare workers had moderate social commitments and 90.8% had high social commitments. Chi-square showed that education (p = 0.001), job position (p = 0.001) and the area in which healthcare workers were present for service (p = 0.002) were significantly associated with organizational commitments. According to OR in the logistic regression model, healthcare workers with master’s and doctoral education levels had 3.482 times more social commitments than others and the health group had 2.455 times more social commitments compared to the treatment group. CONCLUSION: The results of this study showed that at the time of the coronavirus outbreak, the healthcare workers in Babol had very positive and high organizational and social commitments. As the world struggles with the coronavirus pandemic, employee and organizational productivity may decline due to the fear and anxiety of healthcare workers in various organizations. It is expected that managers of health-related organizations, social, economic, and cultural organizations use the results of this study to identify factors affecting the organizational and social commitments of employees and strengthen them.

Evaluation of organizational and social commitments and related factors during the coronavirus pandemic of healthcare workers in northern Iran

OBJECTIVE: To evaluate B-cell- and T-cell-mediated immune response to SARS-CoV-2 mRNA vaccination in patients with complex or rare systemic autoimmune diseases previously been treated with or under continuous treatment with B-cell-targeted therapies including rituximab (RTX) and belimumab (BEL). MATERIALS AND METHODS: Twenty-eight consecutive patients receiving RTX (n = 11) or BEL (n = 17) treatment and 13 age-/sex-matched controls (non-rheumatic healthcare personnel) were recruited. None of the patients had detectable anti-SARS-CoV-2 antibodies caused by prior exposure to the virus. All the patients and controls received mRNA vaccines and were tested three to four weeks after completion of vaccination. In all the RTX patients, vaccination was started within 5 months from the last infusion, and B-cell depletion was confirmed in all but one of them. Total anti-SARS-CoV-2 RBD antibodies were analyzed using a diagnostic assay, while T-cell response was evaluated using the interferon-gamma release assay (IGRA). Further, SARS-CoV-2 pseudoviruses were employed to verify the strain-specific neutralizing capacity of the antibodies. RESULTS: Detectable anti-SARS-CoV-2 antibodies were documented in 1 out of the 11 RTX patients and 16 of the 17 BEL patients. The median concentration in the RTX and BEL patients was significantly lower than that in the controls (39.6 AU/ml vs. 1133 AU/ml, p = 0.002). The result of IGRA was positive in 8 of the 11 (72.7%) RTX patients and 16 of the 17 (94.1%) BEL patients, and interferon release in both the RTX and BEL patients was comparable to that in the control participants. CONCLUSION: B-cell-targeted therapies do not preclude SARS-CoV-2 vaccination, since virus-specific cellular immunity can be induced even in the absence of circulating B cells. An important finding was that lupus patients treated with BEL developed immune responses to SARS-CoV-2; this indicates retention of the immunogenicity of the COVID-19 vaccine.

High T-cell response rate after COVID-19 vaccination in belimumab and rituximab recipients

El Dengue y la Leptospirosis son enfermedades metaxénicas endémicas que afectan áreas tropicales y subtropicales, en su mayoría de los países subdesarrollados. Sumado a ello la pandemia por el COVID-19, estos vienen generando mucho daño tanto a la población como a nivel sanitario. Se presenta el caso de una paciente de 13 años que cursó con fiebre, sangrado gingival e intermenstrual, dolor abdominal y dificultad respiratoria. Tuvo prueba rápida SARS-CoV-2 IgM e IgG positivo, y serología positiva NS1 para Dengue e IgM para Leptospira. Además, en la Tomografía Pulmonar sin contraste se evidenciaron áreas de consolidados y de vidrio esmerilado a nivel de las bases, además de cisuritis. Se tuvieron los diagnósticos de Neumonía COVID-19, Dengue con signos de alarma y Leptospirosis. La terapéutica se basó en fluidoterapia según la diuresis y presión arterial, sintomáticos, soporte oxigenatorio, monitoreo constante y antibioticoterapia con Ceftriaxona, teniendo una evolución favorable.

Dengue With Signs Of Alarm And Leptospirosis In A Pediatric Patient With COVID-19/ Dengue con signos de alarma y Leptospirosis en un paciente pediátrico con COVID-19

INTRODUCTION: While there has been considerable analysis of the health and economic effects of COVID-19 in the Global North, representative data on the distribution and depth of social and economic impacts in Africa has been more limited. METHODS: We analyze household data collected prior to the COVID-19 pandemic and during the first wave of COVID in four African countries. We evaluate the short-term changes to household economic status and assess women’s access to health care during the first wave of COVID-19 in nationally representative samples of women aged 15–49 in Kenya and Burkina Faso, and in sub-nationally representative samples of women aged 15–49 in Kinshasa, Democratic Republic of Congo and Lagos, Nigeria. We examine prevalence and distribution of household income loss, food insecurity, and access to health care during the COVID-19 lockdowns across residence and pre-pandemic wealth categories. We then regress pre-pandemic individual and household sociodemographic characteristics on the three outcomes. RESULTS: In three out of four samples, over 90% of women reported partial or complete loss of household income since the beginning of the coronavirus restrictions. Prevalence of food insecurity ranged from 17.0% (95% CI 13.6–20.9) to 39.8% (95% CI 36.0–43.7), and the majority of women in food insecure households reported increases in food insecurity during the COVID-19 restriction period. In contrast, we did not find significant barriers to accessing health care during COVID restrictions. Between 78·3% and 94·0% of women who needed health care were able successfully access it. When we examined pre-pandemic sociodemographic correlates of the outcomes, we found that the income shock of COVID-19 was substantial and distributed similarly across wealth groups, but food insecurity was concentrated among poorer households. Contrary to a-priori expectations, we find little evidence of women experiencing barriers to health care, but there is significant need for food support.

The wealth gradient and the effect of COVID-19 restrictions on income loss, food insecurity and health care access in four sub-Saharan African geographies

Tracheostomies are often utilized in critically ill patients on prolonged mechanical ventilation, to enhance respiratory function and facilitate ventilator weaning. Many coronavirus disease 2019 (COVID-19) patients develop serious respiratory illness requiring ventilator management. In the early phase of this pandemic, the risk of disease spread lead to the development of conservative guidelines which advocated delaying tracheostomy at least two to three weeks from intubation and, preferably, with negative COVID-19 testing. The morbidly obese patient population, however, presents a unique scenario in which early tracheostomy may be beneficial. In this article, we discuss our institution's current practices along with clinical outcomes with reference to intensive care literature and propose that early tracheotomy in COVID-19 patients should be considered on a case by case basis.

Early Tracheostomy in Morbidly Obese COVID-19 Patients: A Case Series and Discussion of Institutional Practices

We wanted to test the hypothesis that the efficacy of systemic corticosteroid is associated with atopic characteristics in wheezing children. A randomized controlled trial comparing oral prednisolone (2 mg/kg/day in 3 divided doses for 3 days) with placebo in hospitalized wheezing children (n = 266, median 1.6 years, range 3 months to 15.2 years) was conducted. In this post‐hoc analysis, we assessed the link between the efficacy of prednisolone and several atopic characteristics, such as atopy, aeroallergen sensitization, total IgE level, number of sensitizations, eczema, atopic eczema, blood or nasal eosinophils, exhaled nitric oxide, positive modified asthma predictive index/asthma, inhaled corticosteroid medication and parental asthma/allergy. Virology was studied comprehensively. Our primary endpoint was the time until ready for discharge, and the most important secondary endpoint was the occurrence of relapses during the following 2 months. For statistics, we used interaction analyses in uni‐ and multivariate regression models. Overall, prednisolone did not decrease any of our predefined clinical endpoints. Neither was the efficacy of prednisolone associated with atopy. However, prednisolone significantly decreased the time until ready for discharge in children with positive modified asthma predictive index/asthma, inhaled corticosteroids, or rhinovirus infection and/or in children without azithromycin treatment. Prednisolone significantly decreased relapses in children with eczema, nasal eosinophilia and rhinovirus infection. The multiple clinical, inflammatory and viral markers associating with the efficacy of prednisolone should be confirmed in prospective trials. It is important that corticosteroid intervention trials have strict design for these potentially confounding factors. Pediatr Pulmonol. 2007; 42:1125–1133. © 2007 Wiley‐Liss, Inc.

Atopic characteristics of wheezing children and responses to prednisolone

BACKGROUND: Erectile dysfunction (ED), as the hallmark of endothelial dysfunction, could be a short- or long-term complication of COVID-19. Additionally, being ED a clinical marker and predictor of non-communicable chronic diseases, particularly cardiovascular, subjects with ED could potentially have a higher risk of contracting COVID-19. OBJECTIVES: To investigate the prevalence of ED among subjects with a reported diagnosis of COVID-19 and to measure the association of COVID-19 and ED. MATERIALS AND METHODS: We reviewed data from the Sex@COVID online survey (performed between April 7 and May 4, 2020, in Italy) to retrieve a sample of Italian male sexually active subjects with reported SARS-CoV-2 infection. A matching sample of COVID-19-negative male sexually active subjects was also retrieved using propensity score matching in a 3:1 ratio. The survey used different standardized psychometric tools to measure effects of lockdown and social distancing on the intrapsychic, relational, and sexual health of Italian subjects. RESULTS: One hundred subjects were included in the analysis (25 COVID-positive; 75 COVID-negative). The prevalence of ED, measured with the Sexual Health Inventory for Men, was significantly higher in the COVID+ group (28% vs. 9.33%; p = 0.027). Logistic regression models confirmed a significant effect of COVID-19 on the development of ED, independently of other variables affecting erectile function, such as psychological status, age, and BMI [OR 5.66, 95% CI: 1.50-24.01]. Likewise, subjects with ED were more likely to have COVID-19, once corrected for age and BMI [OR 5.27, 95% CI: 1.49-20.09]. DISCUSSION AND CONCLUSION: On top of well-described pathophysiological mechanisms, there is preliminary evidence in a real-life population of ED as a risk factor of developing COVID-19 and possibly occurring as a consequence of COVID-19. Universal vaccination against the COVID-19 and the personal protective equipment could possibly have the added benefit of preventing sexual dysfunctions.

"Mask up to keep it up": Preliminary evidence of the association between erectile dysfunction and COVID-19

We formulate three basic assumptions that should ideally guide any well-designed COVID-19 prevalence study. We provide, on the basis of these assumptions alone, a full derivation of mathematical formulas required for statistical analysis of testing data. In particular, we express the disease prevalence in a population through those for its homogeneous subpopulations. Although some of these formulas are routinely employed in prevalence studies, the study design often contravenes the assumptions upon which these formulas vitally depend. We also designed a natural prevalence estimator from the testing data and studied some of its properties. The results are equally valid for diseases other than COVID-19 as well as in non-epidemiological settings.

The Mathematics of Testing with Application to Prevalence of COVID-19

BACKGROUND: Venous thromboembolism (VTE) is a frequent complication of COVID-19, so that the importance of adequate in-hospital thromboprophylaxis in patients hospitalized with COVID-19 is well established. However, the incidence of VTE after discharge and whether postdischarge thromboprophylaxis is beneficial and safe are unclear. In this prospective observational single-center study, we report the incidence of VTE 6 weeks after hospitalization and the use of postdischarge thromboprophylaxis. METHODS: Patients hospitalized with confirmed COVID-19 were invited to a multidisciplinary follow-up clinic 6 weeks after discharge. D-dimer and C-reactive protein were measured, and all patients were screened for deep vein thrombosis with venous duplex-ultrasound. Additionally, selected high-risk patients received computed tomography pulmonary angiogram or ventilation-perfusion (V/Q) scan to screen for incidental pulmonary embolism. RESULTS: Of 485 consecutive patients hospitalized from March through June 2020, 146 patients were analyzed, of which 39% had been admitted to the intensive care unit (ICU). Postdischarge thromboprophylaxis was prescribed in 28% of patients, but was used more frequently after ICU stay (61%) and in patients with higher maximal D-dimer and C-reactive protein levels during hospitalization. Six weeks after discharge, elevated D-dimer values were present in 32% of ward and 42% of ICU patients. Only one asymptomatic deep vein thrombosis (0.7%) and one symptomatic pulmonary embolism (0.7%) were diagnosed with systematic screening. No bleedings were reported. CONCLUSION: In patients who had been hospitalized with COVID-19, systematic screening for VTE 6 weeks after discharge revealed a low incidence of VTE. A strategy of selectively providing postdischarge thromboprophylaxis in high-risk patients seems safe and potentially effective.

Venous Thromboembolism in Patients Discharged after COVID-19 Hospitalization

Keterbukaan data terkait penanganan COVID-19 memiliki manfaat bagi masyarakat salah satunya bisa meningkatkan kewaspadaan dalam menghadapi wabah COVID-19. Penggunaan teknologi Business Intelligence (BI) mampu untuk mengumpulkan menyimpan mengorganisasikan dan meringkas data serta menyediakan informasi. Penelitian ini bertujuan untuk mendeskripsikan kasus COVID-19 dengan mengimplementasikan Business Intelligence sebagai alat analisis yang divisualisasikan kedalam peta sebaran Orang Dalam Pantauan (ODP) Pasien Dalam Pantauan (PDP) dan Pasien Positif serta grafik terkonfirmasi sembuh dan meninggal. Penelitian ini menggunakan data historis kasus COVID-19 Jawa Barat selama 14 hari dengan 3 kejadian yaitu sebelum selama dan sesudah dilakukannya Pembatasan Sosial Berskala Besar (PSBB). Adapun metodologi penelitian menggunakan analisis deskriptif dengan tools Tableau Public. Hasil Penelitian menunjukkan bahwa jumlah kasus positif masih terus mengalami kenaikan selama PSBB dan jumlah penderita yang sembuh selama PSBB di Jawa Barat juga masih relatif sedikit. Tingkat kesembuhan pasien selama PSBB mencapai 1795 persen dan kematian selama PSBB meningkat dibandingkan sebelum dan sesudah PSBB. Kata Kunci: COVID-19 Pandemi Business Intelligence Tableu Public

Implementasi business intelligence untuk menganalisis perbandingan data kasus COVID-19 di Jawa barat sebelum PSBB dan setelah PSBB

This study investigated the birnessite (δ-MnO2) catalyzed oxidative removal of 1,4-naphthoquinone (1,4-NPQ) in the presence of phenolic mediators;specifically, the kinetics of 1,4-NPQ removal under various conditions was examined, and the reaction pathway of 1,4-NPQ was verified by liquid chromatography-tandem mass spectrometry (LC-MS/MS) The removal rate of 1,4-NPQ by birnessite-catalyzed oxidation (pH = 5) was faster in the presence of phenolic mediators with electron-donating substituents (pseudo-first-order initial stage rate constant (k1) = 0 380-0 733 h-1) than with electron-withdrawing substituents (k1 = 0 071-0 244 h-1), and the effect on the substituents showed a positive correlation with the Hammett constant (&amp;#931;&amp;#963;) (r2 = 0 85, p &lt;0 001) The rate constants obtained using variable birnessite loadings (0 1-1 0 g L-1), catechol concentrations (0 1-1 0 mM), and reaction sequences indicate that phenolic mediators are the major limiting factor for the cross-coupling reaction of 1,4-NPQ in the initial reaction stages, whereas the birnessite-catalyzed surface reaction acts as the major limiting factor in the later reaction stages This was explained by the operation of two different reaction mechanisms and reaction products identified by LC-MS/MS

Removal of 1,4-Naphthoquinone by Birnessite-Catalyzed Oxidation: Effect of Phenolic Mediators and the Reaction Pathway

This chapter discusses the continuing search for antiviral drugs. Many virus diseases, both of humans and animals, have been successfully controlled by vaccines. These successes have naturally led to improvements in the spectrum and duration of protection offered by vaccines until, at present it is difficult to see how antiviral drugs could compete with vaccines in the control of many virus diseases. One may cite smallpox, yellow fever, polio, and recently measles among human diseases, Newcastle disease, Marek's disease, and infectious bronchitis among poultry diseases—an area of veterinary disease control where vaccines have been particularly important. Research into the treatment of virus diseases by drugs is at present directed toward three general areas: (1) attempts to stimulate the defense mechanism of the host animal, (2) large screening programs to find drugs which directly block some virus-specific process, and (3) alleviation of the symptoms of the disease. The treatment of the symptoms, rather than the cause of a disease, has been the mainstay of medical practice from time immemorial, and this is still the case with most virus disease. The short incubation period of many virus diseases will inevitably restrict the therapeutic use of antiviral drugs and in cases where symptoms have already appeared.

The Continuing Search for Antiviral Drugs

The outbreak of COVID-19 has spurred extensive research worldwide to develop a vaccine. However, when a vaccine becomes available, limited production and distribution capabilities will likely lead to another challenge: who to prioritize for vaccination to mitigate the near-end impact of the pandemic? To tackle that question, this paper first expands a state-of-the-art epidemiological model, called DELPHI, to capture the effects of vaccinations and the variability in mortality rates across subpopulations. It then integrates this predictive model into a prescriptive model to optimize vaccine allocation, formulated as a bilinear, non-convex optimization model. To solve it, this paper proposes a coordinate descent algorithm that iterates between optimizing vaccine allocations and simulating the dynamics of the pandemic. We implement the model and algorithm using real-world data in the United States. All else equal, the optimized vaccine allocation prioritizes states with a large number of projected cases and subpopulations facing higher risks (e.g., older ones). Ultimately, the optimized vaccine allocation can reduce the death toll of the pandemic by an estimated 10-25%, or 10,000-20,000 deaths over a three-month period in the United States alone.

Optimizing Vaccine Allocation to Combat the COVID-19 Pandemic

The COVID-19 pandemic and response measures, including lockdowns and the reorientation of health services, have disrupted essential health services for other diseases, including TB, HIV and malaria. For TB, reductions in case detection due to the COVID-19 pandemic are projected to result in increased TB transmission, morbidity and mortality. Active case-finding (ACF) for TB using community-based approaches is a potential strategy to offset reductions in TB detection by obviating the need for patients to seek care at a health facility. A number of approaches can be used to conduct TB ACF safely and screen designated target populations while managing the risks of SARS-CoV-2 transmission for staff, individuals and the community. We present a framework of options for and experience of adapting TB ACF services in response to the challenges of COVID-19 in our programme in Yogyakarta, Indonesia. Key changes have included revised prioritisation of target populations focusing on household contacts, reducing case-finding throughput, implementation of additional infection control measures and precautions, and integration of COVID-19 screening among those being screened for TB. Our approach could inform other programmes seeking to adapt TB ACF services to mitigate the negative impact of COVID-19 on TB case detection.

Adapting active case-finding for TB during the COVID-19 pandemic in Yogyakarta, Indonesia.

At the outset of the pandemic, SARS-CoV-2 was thought to present simply as persistent cough and fever. However, with time, the medical community noted a myriad of associated symptoms well-described in the literature. Medical complications were particularly common in elderly populations and many early publications described pneumonia, organ failure, acute respiratory distress syndrome, hypercoagulability/microthrombosis and superimposed bacterial/viral infections. There is, however, a lack of literature describing surgical complications of COVID-19 and as such little knowledge regarding safe surgical interventions. This case describes the presentation/management of a patient who developed COVID-19-associated necrotising pneumonia. Video-assisted thoracoscopy lobectomy was performed following CT demonstration of necrotising pneumonia. Pathological evaluation of the surgical resection specimen demonstrated the microarchitecture of a severely diseased COVID-19 lung-fibrosis. This case demonstrates the safe management of a necrotic lung using a minimal access approach in the context of COVID-19 infection.

Surgical management of a COVID-19-associated necrotic pneumonia

Tyrosine kinase inhibitors that target the BCR/ABL mutation have been used as therapies of BCR/ABL positive acute lymphoblastic leukemia (ALL) with significant results. Dasatinib is a multitargeted tyrosine kinase inhibitor with significant activity in Philadephia positive ALL which is resistant to imatinib, as well as in treatment-naïve patients. We present a case of an elderly patient with Philadelphia chromosome-positive ALL, who presented with acute hypoxic respiratory failure in the setting of active immunotherapy with dasatinib.

The Hidden Variable: A Case of Dasatinib-Induced Respiratory Failure

BACKGROUND: Using social media (SM) for educational purposes might improve academic performance. AIM: This paper aims to describe health science students’ use of SM for educational purposes and its association with their academic performance. METHODS: Two hundred ninety-seven undergraduate health science students completed a self-administered questionnaire comprising 4 sections related to social media. RESULTS: Almost all students (99.7%) reported using SM for learning, most (90.9%) of them daily. The most preferred type of SM learning was Facebook. Most students thought that using SM for learning is convenient and useful. They suggested there should be 1 Facebook account for each subject, that every classmate could access to obtain knowledge from lecturers and to interact between students and lecturers. The logistic regression model showed that the more time students practiced following the advice on posted information, the more likely they were to achieve a GPA at distinction level or above (OR = 4.2; OR = 5.4, and OR = 9.4, respectively with times of practicing). Conversely, the students who used SM for learning less than once a month were less likely to obtain a GPA at distinction level (OR = 0.5). CONCLUSIONS: Almost all health science students used SM to support learning and use of SM for learning was associated with higher academic performance.

Health Science Students’ Use of Social Media for Educational Purposes: A Sample from a Medical University in Hanoi, Vietnam

Do populist leaders contribute to the spread of coronavirus disease 2019 (COVID-19)? While all governments have struggled to respond to the pandemic, it is now becoming clear that some political leaders have performed much better than others. Among the worst performing are those that have risen to power on populist agendas, such as in the United States, Brazil, Russia, India, and the United Kingdom. Populist leaders have tended to: blame "others" for the pandemic, such as immigrants and the Chinese government; deny evidence and show contempt for institutions that generate it; and portray themselves as the voice of the common people against an out-of-touch 'elite.' In our short commentary, focusing on those countries with the most cases, we find that populist leaders appear to be undermining an effective response to COVID-19. Perversely, they may also gain politically from doing so, as historically populist leaders benefit from suffering and ill health. Clearly more research is needed on the curious correlation of populism and public health. Notwithstanding gaps in the evidence, health professionals have a duty to speak out against these practices to prevent avoidable loss of life.

Are Populist Leaders Creating the Conditions for the Spread of COVID-19? Comment on "A Scoping Review of Populist Radical Right Parties' Influence on Welfare Policy and its Implications for Population Health in Europe"

Parkinson's disease (PD) is a movement disorder associated with the progressive loss of dopaminergic neurons (DA). PD treatment remains unsatisfactory as the current synthetic drugs in clinical use relies on managing only motor symptoms. This study investigated antioxidant potentials of selected compounds namely, 5,6,7,4´-tetramethoxyflavone (1), 6-hydroxy-2,3,4,4´-tetramethoxychalcone (2), 6-methoxyhamiltone A (3), diosquinone (4) and toussantine D (5) against rotenone (6) induced PD in Drosophila melanogaster. Toxicity of these compounds was conducted by monitoring flies' survival for seven days and determining the lethal concentrations (LC50). Whereas compound 1 had LC50 value of 91.3 µM within three days, compounds 2, 3, 4, and 5 had LC50 values of 87.2, 58.0, 64.0 and > 1000 µM, respectively on the seventh day of the experiment. We exposed flies (1-4 days old) to 500 µM rotenone and co-treated with different doses of the test compounds in the diet for seven days at final concentrations of 11.0, 43.6 and 87.2 µM for compounds 2 and 3. The concentrations used for compound 4 were 8.0, 32.0 and 64.0 µM, while 250, 500 and 1000 µM were used for compound 5. Rotenone fed flies showed impaired climbing ability compared to control flies, the phenotype that was rescued by the treatment of tested phytochemicals. Rotenone toxicity also increased malondialdehyde levels assayed by lipid peroxidation in the brain tissues relative to control flies. This effect was reduced in flies exposed to rotenone and co-treated with the phytochemicals. Moreover, expression levels of mRNA of antioxidant enzymes; superoxide dismutase and catalase were elevated in flies treated with rotenone and normalized in flies that were co-treated with tested compounds. Besides compound 1, this study provides overall evidence that the tested flavonoids and polyketides ameliorated the rotenone provoked neurotoxicity in D. melanogaster by battling the induced oxidative stress in brain cells including DA neurons and hence rescue the locomotor behaviour deficits.

Ameliorative effects of flavonoids and polyketides on the rotenone induced Drosophila model of Parkinson's disease.

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected the sleep quality of individuals, and is a poorly investigated area. This study aimed to investigate the prevalence estimate of poor sleep quality and its associated factors among Bangladeshi residents during the COVID-19 pandemic. Methods: An online cross-sectional survey was carried out from July 20 to August 5, 2020, involving 975 Bangladeshi residents (male: 54.2%; mean age: 26.7 ± 9.4 years; age range: 18–75 years). A self-reported questionnaire was answered by the respondents, covering information on demographic characteristics, perceived physical health status, COVID-19-related factors, COVID-19-induced anxiety assessment, and sleep quality. To assess sleep quality, the Bangla version of the Pittsburgh Sleep Quality Index was used. Logistic regression models were performed to analyze the factors associated with sleep quality. Results: The prevalence estimate of poor sleep quality was 55.1% among the Bangladeshi people during the COVID-19 pandemic. As per the multiple regression analysis, poor sleep quality was significantly higher among respondents who reported female gender, moderate/poor health status, indirect contact with COVID-19 infected patients, decreased household income due to the COVID-19 pandemic, fear of infection, and COVID-19-induced anxiety. Conclusion: Poor sleep quality was slightly prevalent among general people in Bangladesh during the COVID-19 pandemic. The findings indicate an immediate response for this vulnerable group to improve the sleep quality during the public health emergency of COVID-19.

Investigating Poor Sleep Quality and Associated Factors During the COVID-19 Pandemic: A Population-Based Survey in Bangladesh

OBJECTIVES: Identify and summarize the available literature on the acceleration in the use of telemedicine in the midst of the COVID-19 pandemic, with an aim to provide justification and guidance for its implementation to overcome the limitations associated with the pandemic worldwide. METHODS: We conducted a scoping review through different search strategies in MEDLINE and Google Scholar to identify the available literature reporting data on implementation and usefulness of various modalities of telemedicine during the current pandemic. We summarized the included studies according to field and mode of implementation in a narrative way. RESULTS: We included 45 studies that fulfilled selection criteria. About 38% of the studies were conducted in the United States of America (USA), followed by 15.5% in India and 15.5% in China. Most studies (73%) were cross-sectional studies based on historical records. All publications were written in English with the exception of 1 studied published in Spanish. The majority of reports focused on use of telemedicine for outpatient care, followed by in-hospital care. CONCLUSION: The COVID-19 pandemic has promoted the use of telemedicine, a tool that has transformed the provision of medical services. Several modes of implementation are useful to overcome difficulties for patient care during the pandemic. Its benefits are specific to different fields of medical practice. Such benefits, along with the guidance and reported experiences should invite health systems to work for an effective and comprehensive implementation of telemedicine in various fields.

Implementation and Usefulness of Telemedicine During the COVID-19 Pandemic: A Scoping Review

This paper presents a demonstration of our PAAMS 2021 paper using data-driven analysis of airport terminal operations and An Agent-based Airport Terminal Operations Model Simulator (AATOM). The goal of this paper is to demonstrate and analyze the impact of the current COVID-19 and future pandemic-related measures on airport terminal operations and to identify plans that airport management agents can take into account to control the flow of passengers in a safe, efficient, secure and resilient way. To analyze the impact of the identified COVID-19 measures on the airport operations, the existing agent-based AATOM model was need to be modified in order to implement these measures. In this paper, we illustrate a demo of a developed simulator tool by investigating the effects of different degrees of physical distancing rules among agents on the performances of the airport. In the demo session the attendees will have the possibility to (i) work with the simulator tool on different relevant parameters regarding different sections and agents in the airport;(ii) view and analyze different performance indicator analyzers of the simulator. © 2021, Springer Nature Switzerland AG.

Demo Paper: A Tool for Analyzing COVID-19-Related Measurements Using Agent-Based Support Simulator for Airport Terminal Operations

BACKGROUND Graves' orbitopathy (GO) is the most common extrathyroidal manifestation of Graves' disease (GD). Several studies support the involvement of TSH receptor autoantibodies (TRAbs) in the pathogenesis of GO, and a correlation between GO features and TRAbs has been reported, but not confirmed by all studies. Thus, we conducted a cross-sectional investigation to determine whether there is a correlation between TRAbs and the clinical features of GO in an initial phase of the eye disease. METHODS Ninety consecutive patients with untreated GO (67 women and 23 men, age 48.9 ± 12.6 years) were included. Patients who had received treatments other than anti-thyroid drugs for hyperthyroidism or lubricants for GO were excluded. All patients underwent an endocrinological and ophthalmological evaluation, the latter including exophthalmometry, measurement of eyelid width, clinical activity score (CAS), visual acuity, assessment of diplopia, and NOSPECS score. TRAb levels were measured by a third-generation competitive immunoassay. RESULTS There was a statistically significant, direct correlation between serum TRAb levels and CAS by linear regression analysis (R = 0.278, P = 0.007). The correlation was confirmed by a multiple regression analysis (R = 0.285; P = 0.006) including age and FT3 levels, which also correlated with CAS. There were no relationships between TRAbs and exophthalmometry, eyelid aperture, degree of diplopia, visual acuity, and NOSPECS score. CONCLUSIONS The levels of TRAb in subjects with a recent-onset, untreated GO are directly correlated with the clinical activity of the disease, confirming a possible role of these antibodies in the pathogenesis of GO.

Correlation between serum anti-TSH receptor autoantibodies (TRAbs) and the clinical feature of Graves' orbitopathy.

Our understanding of COVID-19 in pregnant and postpartum women is rapidly evolving. We present a case from March 2020 of a 25-year-old G2P2002 whose delivery was complicated by preeclampsia with severe features who presented to the emergency department 9 days after cesarean delivery with chest tightness and dyspnea on exertion. On presentation she had severe hypertension, pulmonary edema, elevated brain natriuretic peptide, and high-sensitivity troponin-I, suggesting a diagnosis of hypertensive emergency leading to heart failure with a preserved ejection fraction resulting in pulmonary edema and abnormal cardiac screening tests. However, bilateral opacities were seen on a computed tomography of the chest, and COVID-19 testing was positive. A high index of suspicion for both COVID-19 and cardiovascular complications are critical for optimal patient outcomes and protection of health care workers.

Heart Failure with Preserved Ejection Fraction in a Postpartum Patient with Superimposed Preeclampsia and COVID-19

To evaluate the efficacy of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) vs calcium channel blockers (CCBs) on the progression of Corona Virus Disease 2019 (COVID-19) patients with hypertension in Wuhan. This retrospective single-center case series analyzed COVID-19 patients with hypertension, treated with ACEIs/ARBs or CCBs at the Tongji Hospital of Wuhan City, China from 25th January to 15th March 2020. After propensity score matching analysis, 76 patients were selected into two groups. Univariate and multivariable analyses were conducted to determine factors related to improvement measures and outcome measures by Cox proportional hazard regression models. Among 157 patients with confirmed COVID-19 combined hypertension, including 73 males and 84 females, a median age of 67.28 ± 9.11 vs 65.39 ± 10.85 years. A univariable analysis indicated that clinical classification, lymphocyte count, and interleukin-2 receptor were associated with a lengthened negative time of nucleic acid, with a significant difference between two groups (P = .036). Furthermore, we found no obvious difference in nucleic acid conversion time between ACEIs/ARBs and CCBs groups (hazard ratio [HR]: 0.70; 95% confidence interval [CI]: [0.97, 3.38]; P = .18) in the multivariable analysis as well as chest computed tomography improved time (HR: 0.73; 95% CI [0.45, 1.2]; P = .87), and hospitalization time between ACEIs/ARBs and CCBs groups (HR: 1.06; 95% CI [0.44, 1.1]; P = .83). Our study provided additional evidence of no obvious difference in progress and prognosis between ACEIs/ACEIs and CCBs group, which may suggest ACEIs/ARBs may have scarcely influence on increasing the clinical severe situations of COVID-19 patients with hypertension.

Efficacy of ACEIs/ARBs vs CCBs on the progression of COVID-19 patients with hypertension in Wuhan: A hospital-based retrospective cohort study

Marine ecosystems and their associated biodiversity sustain life on Earth and hold intrinsic value. Critical marine ecosystem services include maintenance of global oxygen and carbon cycles, production of food and energy, and sustenance of human wellbeing. However marine ecosystems are swiftly being degraded due to the unsustainable use of marine environments and a rapidly changing climate. The fundamental challenge for the future is therefore to safeguard marine ecosystem biodiversity, function, and adaptive capacity whilst continuing to provide vital resources for the global population. Here, we use foresighting/hindcasting to consider two plausible futures towards 2030: a business-as-usual trajectory (i.e. continuation of current trends), and a more sustainable but technically achievable future in line with the UN Sustainable Development Goals. We identify key drivers that differentiate these alternative futures and use these to develop an action pathway towards the desirable, more sustainable future. Key to achieving the more sustainable future will be establishing integrative (i.e. across jurisdictions and sectors), adaptive management that supports equitable and sustainable stewardship of marine environments. Conserving marine ecosystems will require recalibrating our social, financial, and industrial relationships with the marine environment. While a sustainable future requires long-term planning and commitment beyond 2030, immediate action is needed to avoid tipping points and avert trajectories of ecosystem decline. By acting now to optimise management and protection of marine ecosystems, building upon existing technologies, and conserving the remaining biodiversity, we can create the best opportunity for a sustainable future in 2030 and beyond.

Safeguarding marine life: conservation of biodiversity and ecosystems

The coronavirus disease (COVID-19) pandemic has changed our lives and still poses a challenge to science. Numerous studies have contributed to a better understanding of the pandemic. In particular, inhalation of aerosolised pathogens has been identified as essential for transmission. This information is crucial to slow the spread, but the individual likelihood of becoming infected in everyday situations remains uncertain. Mathematical models help estimate such risks. In this study, we propose how to model airborne transmission of SARS-CoV-2 at a local scale. In this regard, we combine microscopic crowd simulation with a new model for disease transmission. Inspired by compartmental models, we describe agents' health status as susceptible, exposed, infectious or recovered. Infectious agents exhale pathogens bound to persistent aerosols, whereas susceptible agents absorb pathogens when moving through an aerosol cloud left by the infectious agent. The transmission depends on the pathogen load of the aerosol cloud, which changes over time. We propose a 'high risk' benchmark scenario to distinguish critical from non-critical situations. Simulating indoor situations show that the new model is suitable to evaluate the risk of exposure qualitatively and, thus, enables scientists or even decision-makers to better assess the spread of COVID-19 and similar diseases.

Modelling airborne transmission of SARS-CoV-2 at a local scale

BACKGROUND: Although generally known as a human commensal, Staphylococcus epidermidis is also an opportunistic pathogen that can cause nosocomial infections related to foreign body materials and immunocompromized patients. Infections are often caused by multidrug-resistant (MDR) lineages that are difficult and costly to treat, and can have a major adverse impact on patients' quality of life. Heterogeneity is a common phenomenon in both carriage and infection, but present methodology for detection of this is laborious or expensive. In this study, we present a culture-independent method, labelled Epidome, based on an amplicon sequencing-approach to deliver information beyond species level on primary samples and to elucidate clonality, population structure and temporal stability or niche selection of S. epidermidis communities. RESULTS: Based on an assessment of > 800 genes from the S. epidermidis core genome, we identified genes with variable regions, which in combination facilitated the differentiation of phylogenetic clusters observed in silico, and allowed classification down to lineage level. A duplex PCR, combined with an amplicon sequencing protocol, and a downstream analysis pipeline were designed to provide subspecies information from primary samples. Additionally, a probe-based qPCR was designed to provide valuable absolute abundance quantification of S. epidermidis. The approach was validated on isolates representing skin commensals and on genomic mock communities with a sensitivity of < 10 copies/µL. The method was furthermore applied to a sample set of primary skin and nasal samples, revealing a high degree of heterogeneity in the S. epidermidis populations. Additionally, the qPCR showed a high degree of variation in absolute abundance of S. epidermidis. CONCLUSIONS: The Epidome method is designed for use on primary samples to obtain important information on S. epidermidis abundance and diversity beyond species-level to answer questions regarding the emergence and dissemination of nosocomial lineages, investigating clonality of S. epidermidis communities, population dynamics, and niche selection. Our targeted-sequencing method allows rapid differentiation and identification of clinically important nosocomial lineages in low-biomass samples such as skin samples.

The Epidome - a species-specific approach to assess the population structure and heterogeneity of Staphylococcus epidermidis colonization and infection

This special issue of the Foundations of Computing and Decision Sciences, titled ”Numerical Techniques Meet with OR”, is devoted to the numerical techniques and their applications in real-world phenomena The special issue and its editorial present numerical algorithms as they meet with different research topics such as, e g , from operational research, supply chain management, geometrical structures and Covid-19 effects on financial applications Besides, the special issue covers instructional information about numerical techniques which are useful for OR research problems and real-world applications on such issues © 2021 Sciendo All rights reserved

Editorial – Preface to the special issue on numerical techniques meet with OR

Extracellular vesicles (EVs) are membrane-encapsulated particles released by eukaryotic and prokaryotic cells into the extracellular environment. Depending on their origin, size, and composition, EVs are grouped in several classes, with one of them being exosomes, which are small EVs (SEVs) generated within the endosomal compartment of eukaryotic cells via the unique multivesicular body pathway. Being able to deliver their content (proteins, lipids, small molecules, and nucleic acids) to other cells, exosomes/SEVs are considered as bioactive vesicles with multiple biological functions. Importantly, the composition of exosomes/SEVs depends on the cell and tissue of origin including a set of specific proteins. However, the pathological conditions may lead to the appearance of diseases-specific exosomes/SEVs containing pathology-specific cargoes utilized in the malicious cell-cell communication and spread of malady. Viruses demonstrate complex 'dancing' around the exosome biogenesis system, being able to hijack the host systems responsible for the exosome biogenesis. They use the exosome biogenesis system to promote packaging of their capsids, regulate virion production, and virus secretion. They also utilize a Trojan horse stratagem to place virions inside the SEVs and thereby to spread beyond their normal range of cell hosts using the normal EV uptake process. Another illustration of the virus-based utilization of Trojan horse strategy is given by the ability of human viruses to use exosomes/SEVs as carriers of their exogenous miRNA or viral proteins to the non-infected cells. Taken together, these strategies of dancing with Trojan horses can help viruses to fight with the host defense and to spread the infection.Communicated by Ramaswamy H. Sarma.

Dancing with Trojan horses: an interplay between the extracellular vesicles and viruses.

COVID-19 is a global pandemic spread across more than 200 countries and several measures are being taken to control it. Researchers in pharmaceutical academia/industry are incessantly targeting this disease through vaccine and drug development protocols. Artificial intelligence is being extensively explored for surveillance, diagnostics, contact tracing, and for clinical management of COVID-19. The most common application has been for repurposing of existing drugs through various AI tools. Successful training of artificial neural networks based on identification of specific patterns in binding of known antiviral drugs with protein sequences from diverse virus species have generated models giving good predictions for molecules against SARS-CoV-2 virus, in sync with clinical studies. ML tools have also been used to investigate immunogenic components of the virus to be exploited as vaccine candidates. In this chapter, the utilization of artificial intelligence to accelerate drug-design and vaccine design research for COVID-19 has been reviewed.

Role of artificial intelligence in fast-track drug discovery and vaccine development for COVID-19

The COVID19 infection is known to be disseminated through the droplets ejected by infected individual during coughing, sneezing, speaking and breathing. The spread of the infection will depend on how the droplets evolve in space and time with changing environmental conditions. In view of this, we investigate here the evolution of the droplets under the purview of the Brownian motion of the evaporating droplets in the air under the action of gravity with varying weather conditions. We track the movement of the droplets till either they gravitationally settle on the ground or evaporate to aerosols of size 2$μ$m or below and remain suspended in the air. We find that on the one hand the larger droplets falls on the ground under the action of gravity and on the other hand the smaller droplets evaporate to generate aerosols. The intermediate size droplets are very sensitive to the weather conditions which decides whether they will settle in the ground gravitationally or evaporate to aerosol. Therefore, it is clear that the weather condition play crucial in deciding the intensity of spreading of the infection. The effects of relative humidity and temperature on the evaporation of the droplet are found to be significant. It is also noted that under strong wind flow the droplet can travel large distances. These weather dependence effects indicate that the maintenance of physical separation to evade the virus is not corroborated and hence the use of face mask becomes indispensable.

Airborne virus transmission under different weather conditions

BACKGROUND: Combating the COVID-19 pandemic is a major challenge for health systems, citizens and policy makers worldwide. Early detection of affected patients within the large and heterogeneous group of patients with common cold symptoms is an important element of this effort, but often hindered by limited testing resources, false-negative test results and the lack of pathognomonic symptoms in COVID-19. Therefore, we aimed to identify anamnestic items with an increased/decreased odds ratio for a positive SARS-CoV-2 PCR (CovPCR) result in a primary care setting. METHODS: We performed a multi-center cross-sectional cohort study on predictive clinical characteristics for a positive CovPCR over a period of 4 weeks in primary care patients in Germany. RESULTS: In total, 374 patients in 14 primary care centers received CovPCR and were included in this analysis. The median age was 44.0 (IQR: 31.0–59.0) and a fraction of 10.7% (n = 40) tested positive for COVID-19. Patients who reported anosmia had a higher odds ratio (OR: 4.54; 95%-CI: 1.51–13.67) for a positive test result while patients with a sore throat had a lower OR (OR: 0.33; 95%-CI: 0.11–0.97). Furthermore, patients who had a first grade contact with an infected persons and showed symptoms themselves also had an increased OR for positive testing (OR: 5.16; 95% CI: 1.72–15.51). This correlation was also present when they themselves were still asymptomatic (OR: 12.55; 95% CI: 3.97–39.67). CONCLUSIONS: Several anamnestic criteria may be helpful to assess pre-test probability of COVID-19 in patients with common cold symptoms. SUPPLEMENTARY INFORMATION: Supplementary information accompanies this paper at 10.1186/s12875-020-01322-7.

Risk factors for a positive SARS-CoV-2 PCR in patients with common cold symptoms in a primary care setting – a retrospective analysis based on a joint documentation standard

Introduction Public health emergencies such as pandemics affect the health, safety, and well-being of both individuals and societies. Thus, this study aims to better understand the fear due to coronavirus disease (COVID) and associated levels of anxiety, depression, stress, and coping in the general public of India during the initial stage of the COVID-19 outbreak. Materials and methods This was a cross-sectional study to assess the psychological impact of COVID-19 and coping levels among the general population during the coronavirus pandemic’s initial phase. An online survey was conducted using a snowball sampling technique. Results A total of 489 people responded to the survey. The prevalence rates of depression, anxiety and stress were 27.2%, 21.5%, and 15.3% respectively. Female gender, age below 35 years, history of medical or psychiatric illness, and those who had personal contact with persons with COVID-19 were significantly associated with presence of depression, anxiety, and stress whereas spending more than 1 hour on COVID-19-related information was associated with significant stress. Conclusion This study concludes that the prevalence rates of psychological problems were high during the COVID-19 pandemic. These are directly related to the fear associated with COVID-19 but had an inverse relationship with the resilient coping levels.

Fear, Psychological Impact, and Coping During the Initial Phase of COVID-19 Pandemic Among the General Population in India

In April 2021, 126 active-duty militaries returned to Colombia after a mission in Egypt. Of 29 cases, 28 were B.1.1.7, and one C.36 (first description of this lineage in Colombia). We highlight the militaries as at-risk population and call for implementation of genomic surveillance to improve public health policies in military settings.

Cluster characterization of SARS-CoV-2 in military personnel deployed to Egypt and subsequent introduction of B.1.1.7 and C.36 lineages to Colombia

Despite numerous technological and medical advances, out-of-hospital cardiac arrests (OHCAs) still suffer from suboptimal survival rates and poor subsequent neurological and functional outcomes amongst survivors. Multiple studies have investigated the implementation of high-quality prehospital resuscitative efforts, and across these studies, different terms describing high-quality resuscitative efforts have been used, such as high-performance CPR (HP CPR), multi-tiered response (MTR) and minimally interrupted cardiac resuscitation (MICR). There is no universal definition for HP CPR, and dissimilar designs have been employed. This systematic review thus aimed to review current evidence on HP CPR implementation and examine the factors that may influence OHCA outcomes. Eight studies were systematically reviewed, and seven were included in the final meta-analysis. Random-effects meta-analysis found a significantly improved likelihood of prehospital return of spontaneous circulation (pooled odds ratio (OR) = 1.46, 95% CI: 1.16 to 1.82, p < 0.001), survival-to-discharge (pooled OR = 1.32, 95% CI: 1.16 to 1.50, p < 0.001) and favourable neurological outcomes (pooled OR = 1.24, 95% CI: 1.11 to 1.39, p < 0.001) with HP CPR or similar interventions. However, the studies had generally high heterogeneity (I(2) greater than 50%) and overall moderate-to-severe risk for bias. Moving forward, a randomised, controlled trial is necessary to shed light on the subject.

A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes

Along with COVID-19 pandemic we are also fighting an ‘infodemic’. Fake news and rumors are rampant on social media. Believing in rumors can cause significant harm. This is further exacerbated at the time of a pandemic. To tackle this, we curate and release a manually annotated dataset of 10,700 social media posts and articles of real and fake news on COVID-19. We perform a binary classification task (real vs fake) and benchmark the annotated dataset with four machine learning baselines - Decision Tree, Logistic Regression, Gradient Boost, and Support Vector Machine (SVM). We obtain the best performance of 93.32% F1-score with SVM on the test set. The data and code is available at: https://github.com/parthpatwa/covid19-fake-news-dectection. © 2021, Springer Nature Switzerland AG.

Fighting an Infodemic: COVID-19 Fake News Dataset

Background A large body of empirical evidence on Minorities' Diminished Returns (MDRs) suggests that educational attainment shows smaller health effects for Blacks compared to Whites. At the same time, economic strain may operate as a risk factor for a wide range of undesired mental and physical health outcomes in Black communities. Aim The current study investigated the combined effects of education and economic strain on the following five health outcomes in Black older adults in underserved areas of South Los Angeles: depressive symptoms, number of chronic diseases, pain intensity, self-rated health, and sick days. Methods This cross-sectional study included 619 Black older adults residing in South Los Angeles. Data on demographic factors (age and gender), socioeconomic characteristics, economic strain, health insurance, living arrangement, marital status, health behaviors, depressive symptoms, pain intensity, number of chronic diseases, sick days, and self-rated health were collected. Five linear regressions were used to analyze the data. Results Although high education was associated with less economic strain, it was the economic strain, not educational attainment, which was universally associated with depressive symptoms, pain intensity, self-rated health, chronic diseases, and sick days, independent of covariates. Similar patterns emerged for all health outcomes suggesting that the risk associated with economic strain and lack of health gain due to educational attainment are both robust and independent of type of health outcome. Conclusion In economically constrained urban environments, economic strain is a more salient social determinant of health of Black older adults than educational attainment. While education loses some of its protective effects, economic strain deteriorates health of Black population across domains. There is a need for bold economic and social policies that increase access of Black communities to cash at times of emergency. There is also a need to improve the education quality in the Black communities.

Economic Strain Deteriorates While Education Fails to Protect Black Older Adults Against Depressive Symptoms, Pain, Self-rated Health, Chronic Disease, and Sick Days.

Coronavirus or COVID-19, which has been declared pandemic by the World Health Organization, has incurred huge losses to the lives of people throughout the world. Although, the scientists, researchers and doctors are working round the clock to develop a vaccine for COVID-19, it may take a year or two to make a safe and effective vaccine available for the world. In current circumstances, a solution must be developed to control or stop the spread of the virus. For this purpose, a novel technique based on call data record analysis (CDRA)and contact tracing is proposed that can effectively control the coronavirus outbreak. A positive coronavirus patient can be traced through CDRA and contact tracing. The technique can track the path traversed by the patient and collect the cell numbers of all those people who have met with the patient. Keeping in tact the privacy of this group of people, who are contacted through their cell numbers so that they can isolate themselves till the result of their coronavirus test arrives. If a test result of a person comes positive among the group, then he/she must be isolated and same CDRA and contact tracing procedures are adopted for that person. A COVID-19 patient is geo tagged and alerts are sent if any violation of isolation is done by the patient. Moreover, the general public is informed in advance to avoid the path followed by the patients. This cost effective mechanism is not only capable to control the coronavirus outbreak but also helps in isolating the patient in his/her house.

A Privacy Preserved and Cost Efficient Control Scheme for Coronavirus Outbreak Using Call Data Record and Contact Tracing

Ferroptosis is a type of regulated necrosis that is triggered by a combination of iron toxicity, lipid peroxidation, and plasma membrane damage. The upstream inducers of ferroptosis can be divided into two categories (biological versus chemical) and activate two major pathways (the extrinsic/transporter versus the intrinsic/enzymatic pathways). Excessive or deficient ferroptotic cell death is implicated in a growing list of physiological and pathophysiological processes, coupled to a dysregulated immune response. This review focuses on new discoveries related to how ferroptotic cells and their spilled contents shape innate and adaptive immunity in health and disease. Understanding the immunological characteristics and activity of ferroptotic death not only illuminates an intersection between cell death and immunity but may also lead to the development of novel treatment approaches for immunopathological diseases.

Ferroptosis in infection, inflammation, and immunity

The coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is highly infectious and its ongoing outbreak has been declared a global pandemic by the WHO. Pregnant women are susceptible to respiratory pathogens and the development of severe pneumonia, suggesting the urgent need to assess the potential maternal and infant outcome of pregnancy with COVID-19. The intrauterine vertical transmission potential of SARS-CoV-2 also remains controversial. Herein, we discuss the potential effect of COVID-19 on maternal and infant outcomes based on current studies, including those published in Chinese, in a total of 80 mothers with COVID-19 and 80 infants. We also comprehensively explored the mother-to-child transmission routes of SARS-CoV-2, in particular the route of intrauterine vertical transmission. Given SARS-CoV-2 is a sister to SARS-CoV, of the SARS-related coronavirus species, we made a comprehensive comparison between them to learn from experiences with SARS. Although there is no evidence supporting the intrauterine vertical transmission of SARS-CoV-2, our comprehensive analysis suggests that the adverse maternal and infant outcomes caused by COVID-19 cannot be underestimated. Further, we speculated that the inconsistency between nucleic acids and serological characteristics IgM to SARS-CoV-2 of infants' specimens may be caused by the disruption of the amniotic barrier by the inflammatory factors induced by SARS-CoV-2 infection. Our review is beneficial to understand the effect of SARS-CoV-2 on maternal and infant outcomes.

Potential Effect of COVID-19 on Maternal and Infant Outcome: Lesson From SARS

OBJECTIVE: We assessed whether famotidine improved inflammation and symptomatic recovery in outpatients with mild to moderate COVID-19. DESIGN: Randomised, double-blind, placebo-controlled, fully remote, phase 2 clinical trial (NCT04724720) enrolling symptomatic unvaccinated adult outpatients with confirmed COVID-19 between January 2021 and April 2021 from two US centres. Patients self-administered 80 mg famotidine (n=28) or placebo (n=27) orally three times a day for 14 consecutive days. Endpoints were time to (primary) or rate of (secondary) symptom resolution, and resolution of inflammation (exploratory). RESULTS: Of 55 patients in the intention-to-treat group (median age 35 years (IQR: 20); 35 women (64%); 18 African American (33%); 14 Hispanic (26%)), 52 (95%) completed the trial, submitting 1358 electronic symptom surveys. Time to symptom resolution was not statistically improved (p=0.4). Rate of symptom resolution was improved for patients taking famotidine (p<0.0001). Estimated 50% reduction of overall baseline symptom scores were achieved at 8.2 days (95% CI: 7 to 9.8 days) for famotidine and 11.4 days (95% CI: 10.3 to 12.6 days) for placebo treated patients. Differences were independent of patient sex, race or ethnicity. Five self-limiting adverse events occurred (famotidine, n=2 (40%); placebo, n=3 (60%)). On day 7, fewer patients on famotidine had detectable interferon alpha plasma levels (p=0.04). Plasma immunoglobulin type G levels to SARS-CoV-2 nucleocapsid core protein were similar between both arms. CONCLUSIONS: Famotidine was safe and well tolerated in outpatients with mild to moderate COVID-19. Famotidine led to earlier resolution of symptoms and inflammation without reducing anti-SARS-CoV-2 immunity. Additional randomised trials are required.

Oral famotidine versus placebo in non-hospitalised patients with COVID-19: a randomised, double-blind, data-intense, phase 2 clinical trial

The pandemic of Coronavirus Disease 2019 forms a big threat to all people in the world around us In Iraq, there is a direct increase in the incidence, with a slight decrease in the mortality rate, and that leads us to attempt to find any way to stop or lessen the virus's harmful symptoms In the current study, we used molecular docking to detect the probable inhibitory effect of fifteen natural compounds of some Flavonoids and their derivatives and two antiviral drugs against two of very important SARS-COV-2 proteins the papain like protease (PLpro) and RNA dependent RNA polymerase (RdRp) that was performed using Molecular Operating Environment software(MOE) All the chosen flavonoids and their derivatives, plus the two antiviral drugs docked in the active sites of the viral proteins (PLpro), some of the natural flavonoids like Glycitein 7-O-glucuronide and Theaflavin, gives energy complex scores about-6 96308947 and-6 99058199 Kcal/mol which is better than the energy score is given by Sofosbuvir and Darunavir-6 81020832 and-6 93942785 Kcal/mol respectively And the docking of the compounds into the active sites of (RdRp) protein gives energy binding scores for Theaflavin monogallate-7 84163618 kcal/mol and that better than the complex's score given by docking of the Sofosbuvir and Darunavir into the same protein which gives-7 30999422 and-7 67598867 kcal/mol respectively That’s mean these flavonoids and their derivatives can be used as COVID-19 treatment Otherwise, the infected people with COVID-19 can consume food rich with these Flavonoids to inhibit the virus or at least decrease its symptoms Also from docking of flavonoids into both viral proteins, we can notice that all-natural compounds reported energy binding scores, and the Flavonoid derivatives have a better energy binding score than flavonoid themselves © 2020, Advanced Scientific Research All rights reserved

In-silico study of the inhibitory effect of some flavonoids compounds and their derivatives on SARSCOV-2

Six overlapping viral RNAs are synthesized in cells infected with the avian coronavirus infectious bronchitis virus (IBV). These RNAs contain a 3'-coterminal nested sequence set and were assumed to be viral mRNAs. The seven major IBV virion proteins are all produced by processing of three polypeptides of ca. 23, 51, and 115 kilodaltons. These are the core polypeptides of the small membrane proteins, the nucleocapsid protein, and the 155-kilodalton precursor to the large membrane proteins GP90 and GP84, respectively. To determine which mRNAs specify these polypeptides, we isolated RNA from infected cells and translated it in a messenger-dependent rabbit reticulocyte lysate. Proteins of 23, 51, and 110 kilodaltons were produced. Two-dimensional tryptic peptide mapping demonstrated that these proteins were closely related to the major virion proteins. Fractionation of the RNA before cell-free translation permitted the correlation of messenger activities for synthesis of the proteins with the presence of specific mRNAs. We found that the smallest RNA, RNA A, directs the synthesis of P51, the nucleocapsid protein. RNA C, which contains the sequences of RNA A, directs the synthesis of the small membrane protein P23. RNA E directs the synthesis of the large virion glycoproteins. These results supported a model in which only the unique 5'-terminal domain of each IBV mRNA is active in translation and enabled us to localize genes for virion proteins on the IBV genome.

Coronavirus multiplication: locations of genes for virion proteins on the avian infectious bronchitis virus genome.

According to Iman (2017), the waqf system is a socio-economic alternative to help poor and underprivileged groups in society, through waqf-based entrepreneurship in improving welfare According to Tohirin (2010), cash waqf is a solution to the Indonesian SMEs' lack of access to formal banking institutions The role in question is how cash waqf can move and unify the potential and output of SMEs in an area 2 LITERATURE REVIEW 2 1 The Improvement of Welfare through Cash Waqf Cash Waqf is an instrument that can improve welfare [ ]it is shown by Ahmed (2007) that community empowerment through waqf will improve the standard of life through increased income According to the rating, the proposed long-term solutions are 1) cash waqf blueprint, 2) more specific arrangements, 3) promoting waqf as one of the national endowments, and 4) synergy with zakat management

The Role of Cash Waqf as a Source of Micro Business Financing for Strengthening the Local Economy: A Case Study in Gunung Kawi District, Malang Regency

We consider the query recommendation problem in closed loop interactive learning settings like online information gathering and exploratory analytics. The problem can be naturally modelled using the Multi-Armed Bandits (MAB) framework with countably many arms. The standard MAB algorithms for countably many arms begin with selecting a random set of candidate arms and then applying standard MAB algorithms, e.g., UCB, on this candidate set downstream. We show that such a selection strategy often results in higher cumulative regret and to this end, we propose a selection strategy based on the maximum utility of the arms. We show that in tasks like online information gathering, where sequential query recommendations are employed, the sequences of queries are correlated and the number of potentially optimal queries can be reduced to a manageable size by selecting queries with maximum utility with respect to the currently executing query. Our experimental results using a recent real online literature discovery service log file demonstrate that the proposed arm selection strategy improves the cumulative regret substantially with respect to the state-of-the-art baseline algorithms. % and commonly used random selection strategy for a variety of contextual multi-armed bandit algorithms. Our data model and source code are available at ~\url{https://anonymous.4open.science/r/0e5ad6b7-ac02-4577-9212-c9d505d3dbdb/}.

Max-Utility Based Arm Selection Strategy For Sequential Query Recommendations

Neural Architecture Search is becoming an increasingly popular research field and method to design deep learning architectures Most research focuses on searching for small blocks of deep learning operations, or micro-search This method yields satisfactory results but demands prior knowledge of the macro architecture’s structure Generally, methods that do not utilize macro structure knowledge perform worse but are able to be applied to datasets of completely new domains In this paper, we propose a macro NAS methodology which utilizes concepts of Regularized Evolution and Macro Neural Architecture Search (DeepNEAT), and apply it to the Fashion-MNIST dataset By utilizing our method, we are able to produce networks that outperform other macro NAS methods on the dataset, when the same post-search inference methods are used Furthermore, we are able to achieve 94 46% test accuracy, while requiring considerably less epochs to fully train our network

Regularized Evolution for Macro Neural Architecture Search

Research in youth sports is often complex As interest in youth sports injury prevention grows, scientists should consider community priorities beyond a specific research study This commentary discusses the authors’ personal experiences researching concussion prevention in middle school sports, as the overarching community faced multiple challenges These challenges included a series of weather-related emergencies that resulted in a shift in the community’s priorities, multi-day school closures, and cancellations of sports activities and meetings We discuss the importance of considering community priorities and providing support as scientists, colleagues, and members of the communities in which we conduct research Scientists should consider the changing circumstances and dynamics surrounding community priorities in order to help drive their research-based decisions and ensure successful and respectful applications of research based on community values and priorities

Approaching community priorities in youth sports injury prevention research

Background: Since the novel coronavirus disease (COVID-19) outbreak in Wuhan, thousands of medical workers have been dispatched to support Wuhan against the virus The purpose of this study was to identify the independent risk factors for psychological distress in order to develop a more effective strategy and precise evidence-based psychological intervention for medical workers Methods: This multisite cross-sectional survey recruited doctors and nurses from local and nonlocal medical teams working at 16 hospitals in Wuhan to complete this online survey from February to March, 2020 Psychological status was evaluated through Perceived Stress Scales (PSS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder Scale (GAD-7) and Acute Stress Disorder Scale (ASDS) Results: Of 966 participants, the prevalence of stress (95 9%), depression (46 0%) and anxiety (39 3%) were high Local medical workers exhibited even higher scores of PSS, PHQ-9, GAD-7 and ASDS than those from outside Hubei (P&lt;0 001) Females had more severe perceived stress, depression and anxiety than males (P&lt;0 001) Multiple logistic regression showed that perceived stress is associated with increased odds of depression (OR=1 413;95% CI: 1 338-1 493;P&lt;0 001) and anxiety (OR=1 515;95% CI: 1 407-1 631;P&lt;0 001) Conclusion: Our findings demonstrated a high prevalence of stress, depression, anxiety and acute distress among medical workers on the front-line during the COVID-19 outbreak in Wuhan The level of psychological impact may be mediated by individual perceptions of stressful events

Individual Perceived Stress Mediates Psychological Distress in Medical Workers During COVID-19 Epidemic Outbreak in Wuhan

The interaction between the flow of sentiment expressed on blogs and media and the dynamics of the stock market prices are analyzed through an information-theoretic measure, the transfer entropy, to quantify causality relations. We analyzed daily stock price and daily social media sentiment for the top 50 companies in the Standard & Poor (S&P) index during the period from November 2018 to November 2020. We also analyzed news mentioning these companies during the same period. We found that there is a causal flux of information that links those companies. The largest fraction of significant causal links is between prices and between sentiments, but there is also significant causal information which goes both ways from sentiment to prices and from prices to sentiment. We observe that the strongest causal signal between sentiment and prices is associated with the Tech sector.

Information Theoretic Causality Detection between Financial and Sentiment Data

We propose that the application of network theory to established psychological personality conceptions has great potential to advance a biologically plausible model of human personality. Stable behavioral tendencies are conceived as personality "traits." Such traits demonstrate considerable variability between individuals, and extreme expressions represent risk factors for psychological disorders. Although the psychometric assessment of personality has more than hundred years tradition, it is not yet clear whether traits indeed represent "biophysical entities" with specific and dissociable neural substrates. For instance, it is an open question whether there exists a correspondence between the multilayer structure of psychometrically derived personality factors and the organizational properties of traitlike brain systems. After a short introduction into fundamental personality conceptions, this article will point out how network neuroscience can enhance our understanding about human personality. We will examine the importance of intrinsic (task-independent) brain connectivity networks and show means to link brain features to stable behavioral tendencies. Questions and challenges arising from each discipline itself and their combination are discussed and potential solutions are developed. We close by outlining future trends and by discussing how further developments of network neuroscience can be applied to personality research.

Personality network neuroscience: Promises and challenges on the way toward a unifying framework of individual variability.

To preserve domestic policy autonomy, Tobin called for "an internationally uniform tax on all spot conversions of one currency into another," the goal being to "particularly deter short-term financial round-trip excursions into another currency" (ibid : 155) Because he was skeptical that such moves "by traders in the game of guessing what other traders are going to think" could guide economies toward efficiency, Tobin viewed short-term trading as harmful on the margin The state of New York, home to America's largest capital market, has also taxed stock transfers since 1905, but taxpayers have been able to claim a refund since 1981 (Burman et al 2015: 6) Besides these two taxes, the Securities and Exchange Commission levies a small ad valorem fee on most securities transactions, revenues from which it uses to fund its operations Having abolished its earlier FTT in 2009, France imposed a new one, at a rate of 0 2 percent, which increased to 0 3 percent in 2017, on transactions in the stock of French-headquartered companies with a market value greater than €1 billion (BYN Mellon: 6) [ ]earlier this year Spain passed a tax on stock transactions in Spanish-listed firms with a market cap above €1 billion (Garcia and Blanco 2020)

Financial Transactions Taxes: Inaccessible and Expensive

[This retracts the article DOI: 10.2147/OTT.S118391.].

MicroRNA-145 Inhibits the Activation of the mTOR Signaling Pathway to Suppress the Proliferation and Invasion of Invasive Pituitary Adenoma Cells by Targeting AKT3 in vivo and in vitro [Retraction]

At the beginning of the coronavirus disease 2019 (COVID-19) outbreak, college students returning home from Wuhan, Hubei Province, experienced various degrees of discrimination. This study first investigates perceived discrimination among college students returning home from Wuhan. Then, an experimental method is used to investigate the effectiveness of an intervention designed to reduce the perceived discrimination among those who returned to towns outside of Hubei Province. A total of 63 college students participated in the experiment. In the experimental group (N = 31), a wise intervention based on reading and writing was adopted to intervene in perceived discrimination among the participants. The results showed that the perceived discrimination among students returning from Wuhan to towns outside of Hubei Province was significantly higher than that among students returning to towns within Hubei Province. The wise intervention reduced the perceived discrimination in the experimental group but not in the control group. Further analysis found that perceived social support fully mediated the relationship between the intervention and perceived discrimination. These results provide insights on how the content of intervention (perceived social support) and the form of intervention (wise intervention) can prevent the occurrence of psychological problems in epidemic situations.

Effects of Wise Intervention on Perceived Discrimination Among College Students Returning Home From Wuhan During the COVID-19 Outbreak

Bourbon virus (BRBV) was first isolated from a patient hospitalized at the University of Kansas Hospital in 2014. Since then, several deaths have been reported to be caused by BRBV infection in the Midwest and Southern United States. BRBV is a tick-borne virus that is widely carried by lone star ticks. It belongs to genus Thogotovirus of the Orthomyxoviridae family. Currently, there are no treatments or vaccines available for BRBV or thogotovirus infection caused diseases. In this study, we reconstituted a replicon reporter system, composed of plasmids expressing the RNA-dependent RNA polymerase (RdRP) complex (PA, PB1, and PB2), nucleocapsid (NP) protein, and a reporter gene flanked by the 3′ and 5′ untranslated region (UTR) of the envelope glycoprotein (GP) genome segment. By using the luciferase reporter, we screened a few small molecule compounds of anti-endonuclease that inhibited the nicking activity by parvovirus B19 (B19V) NS1, as well as FDA-approved drugs targeting the RdRP of influenza virus. Our results demonstrated that myricetin, an anti-B19V NS1 nicking inhibitor, efficiently inhibited the RdRP activity of BRBV and virus replication. The IC(50) and EC(50) of myricetin are 2.22 and 4.6 μM, respectively, in cells. Myricetin had minimal cytotoxicity in cells, and therefore the therapeutic index of the compound is high. In conclusion, the BRBV replicon system is a useful tool to study viral RNA replication and to develop antivirals, and myricetin may hold promise in treatment of BRBV infected patients.

Establishment of a Replicon Reporter of the Emerging Tick-Borne Bourbon Virus and Use It for Evaluation of Antivirals

The respiratory mucosa is the primary portal of entry for numerous viruses such as the respiratory syncytial virus, the influenza virus and the parainfluenza virus. These pathogens initially infect the upper respiratory tract and then reach the lower respiratory tract, leading to diseases. Vaccination is an affordable way to control the pathogenicity of viruses and constitutes the strategy of choice to fight against infections, including those leading to pulmonary diseases. Conventional vaccines based on live-attenuated pathogens present a risk of reversion to pathogenic virulence while inactivated pathogen vaccines often lead to a weak immune response. Subunit vaccines were developed to overcome these issues. However, these vaccines may suffer from a limited immunogenicity and, in most cases, the protection induced is only partial. A new generation of vaccines based on nanoparticles has shown great potential to address most of the limitations of conventional and subunit vaccines. This is due to recent advances in chemical and biological engineering, which allow the design of nanoparticles with a precise control over the size, shape, functionality and surface properties, leading to enhanced antigen presentation and strong immunogenicity. This short review provides an overview of the advantages associated with the use of nanoparticles as vaccine delivery platforms to immunize against respiratory viruses and highlights relevant examples demonstrating their potential as safe, effective and affordable vaccines.

Nanoparticle-Based Vaccines Against Respiratory Viruses

A 70-year-old man was diagnosed with coronavirus disease 2019 (COVID-19) pneumonia. Twenty-six days after admission, he experienced hematemesis despite improvement in his respiratory symptoms. Contrast-enhanced computed tomography revealed edematous stomach wall thickening with neither ischemic findings in the gastric wall nor obstruction of the gastric artery. Emergent esophagogastroduodenoscopy showed diffuse dark-red mucosa accompanied by multiple easy-bleeding, irregularly shaped ulcers throughout almost the whole stomach without active bleeding or visible vessels. The clinical course, including the endoscopic findings, progressed favorably with conservative treatment. COVID-19 pneumonia can present with acute gastric mucosal lesion, which may be induced by microvascular thrombosis due to COVID-19-related coagulopathy.

A Rare Case of COVID-19 Pneumonia Concomitant with Bleeding from Acute Gastric Mucosal Lesions

Studies on sleep during the Covid‐19 pandemic have mostly been conducted during the first wave of contagion (spring 2020). To follow up on two Italian studies addressing subjective sleep features during the second wave (autumn 2020), here we assess sleep during the third wave (spring 2021) in a sample of healthy adults from Campania (Southern Italy). Actigraphic data (on 2 nights) and the Pittsburgh Sleep Quality Index were collected from 82 participants (40 F, mean age: 32.5 ± 11.5 years) from 11 March to 18 April 2021, when Campania was classified as a “red zone”, i.e. it was subjected to strict restrictions, only slightly looser than those characterizing the first national lockdown (spring 2020). Although objective sleep duration and architecture appeared in the normal range, the presence of disrupted sleep was indexed by a relevant degree of sleep fragmentation (number of awakenings ≥ 1 min: 12.7 ± 6.12; number of awakenings ≥ 5 min: 3.04 ± 1.52), paralleled by poor subjective sleep quality (Pittsburgh Sleep Quality Index global score: 5.77 ± 2.58). These data suggest that the relevant subjective sleep impairments reported during the first wave could have relied on subtle sleep disruptions that were undetected by the few objective sleep studies from the same period. Taken together with sleep data on previous phases of the pandemic, our findings show that the detrimental effects on sleep determined by the initial pandemic outbreak have not abated across the subsequent waves of contagion, and highlight the need for interventions addressing sleep health in global emergencies.

High sleep fragmentation parallels poor subjective sleep quality during the third wave of the Covid‐19 pandemic: An actigraphic study

Introduction: The ongoing pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has posed important challenges for clinicians and health-care systems worldwide. Areas covered: The aim of this manuscript is to provide brief guidance for intensive care unit management of mechanically ventilated patients with COVID-19 based on the literature and our direct experience with this population. PubMed, EBSCO, and the Cochrane Library were searched up until 15th of January 2021 for relevant literature. Expert opinion: Initially, the respiratory management of COVID-19 relied on the general therapeutic principles for acute respiratory distress syndrome; however, recent findings have suggested that the pathophysiology of hypoxemia in patients with COVID-19 presents specific features and changes over time. Several therapies, including antiviral and anti-inflammatory agents, have been proposed recently. The optimal intensive care unit management of patients with COVID-19 remains unclear; therefore, ongoing and future clinical trials are warranted to clarify the optimal strategies to adopt in this cohort of patients.

Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19

Purpose: The purpose of this study was to investigate the mediating effect of self-leadership on the relationship between media literacy and learning agility in nursing students based on their experiences in online classes during the Coronavirus Disease-19 pandemic. Methods: A descriptive survey was conducted among 165 nursing students from four universities in Busan. Data were collected from June 2 to 13, 2021, and was analyzed using a t-test, one-way ANOVA, Pearson's correlation coefficients, and stepwise multiple regression with SPSS/WIN 26.0. Results: Significant relationships were found between learning agility and media literacy (r=.62, p<.001), between learning agility and self-leadership (r=.58, p<.001), and between media literacy and self-leadership (r=.53, p<.001). Additionally, self-leadership had a partial mediating effect on the relationship between media literacy and learning agility (Z=4.30, p<.001);its explanatory power was 46.0%. Conclusion: These results indicate that interventions to increase the level of media literacy, along with self-leadership, are necessary to improve the level of learning agility of nursing students who will be essential human resources in a rapidly changing healthcare field. Copyright © 2021 Korean Academic Society of Nursing Education.

The mediating effect of self-leadership on the media literacy and learning agility of nursing students based on the experiences of online classes during the COVID-19 pandemic

Anaesthetic management of tracheal resection and reconstruction in patients with difficult tracheal pathologies, poses unique challenges-such as pre-operative assessment and preparation, the induction of general anaesthesia, airway sharing with surgeons during the intra-operative period while performing resection and reconstruction, emergence from general anaesthesia, and post-operative care. While there are no guidelines on choosing the ideal airway technique for the intra-operative period, we describe a simple-yet-effective airway modality, viz. spontaneous ventilation, as a key airway technique during the crucial open airway phase during tracheal reconstruction.

Spontaneous ventilation as a key ventilation technique during open airway phase in tracheal resection and reconstruction: A case series.

In hematological malignancies, leukemias or myelomas, malignant cells present bone marrow (BM) homing, in which the niche contributes to tumor development and drug resistance. BM architecture, cellular and molecular composition and interactions define differential microenvironments that govern cell fate under physiological and pathological conditions and serve as a reference for the native biological landscape to be replicated in engineered platforms attempting to reproduce blood cancer behavior. This review summarizes the different models used to efficiently reproduce certain aspects of BM in vitro; however, they still lack the complexity of this tissue, which is relevant for fundamental aspects such as drug resistance development in multiple myeloma. Extracellular matrix composition, material topography, vascularization, cellular composition or stemness vs. differentiation balance are discussed as variables that could be rationally defined in tissue engineering approaches for achieving more relevant in vitro models. Fully humanized platforms closely resembling natural interactions still remain challenging and the question of to what extent accurate tissue complexity reproduction is essential to reliably predict drug responses is controversial. However, the contributions of these approaches to the fundamental knowledge of non-solid tumor biology, its regulation by niches, and the advance of personalized medicine are unquestionable.

In Vitro Modeling of Non-Solid Tumors: How Far Can Tissue Engineering Go?

On September 11, 2001, the Connecticut Department of Public Health (CDPH) initiated daily, statewide syndromic surveillance based on unscheduled hospital admissions (HASS). The system's objectives were to monitor for outbreaks caused by Category A biologic agents and evaluate limits in space and time of identified outbreaks. Thirty-two acute-care hospitals were required to report their previous day's unscheduled admissions for 11 syndromes (pneumonia, hemoptysis, respiratory distress, acute neurologic illness, nontraumatic paralysis, sepsis and nontraumatic shock, fever with rash, fever of unknown cause, acute gastrointestinal illness, and possible cutaneous anthrax, and suspected illness clusters). Admissions for pneumonia, gastrointestinal illness, and sepsis were reported most frequently; admissions for fever with rash, possible cutaneous anthrax, and hemoptysis were rare. A method for determining the difference between random and systemic variation was used to identify differences of >/=3 standard deviations for each syndrome from a 6-month moving average. HASS was adapted to meet changing surveillance needs (e.g., surveillance for anthrax, smallpox, and severe acute respiratory syndrome). HASS was sensitive enough to reflect annual increases in hospital-admission rates for pneumonia during the influenza season and to confirm an outbreak of gastrointestinal illness. Follow-up of HASS neurologic-admissions reports has led to diagnosis of West Nile virus encephalitis cases. Report validation, syndrome-criteria standardization among hospitals, and expanded use of outbreak-detection algorithms will enhance the system's usefulness.

Hospital admissions syndromic surveillance--Connecticut, September 200-November 2003.

Given the need to increase COVID-19 vaccine uptake among US young adults, we examined the extent of COVID-19 vaccine hesitancy in this population and related factors. We analyzed Fall 2020 survey data from 2,453 young adults (ages 18–34) across 6 US metropolitan statistical areas (MSAs; Mean(age) = 24.67; 55.8% female; 5.4% Black, 12.7% Asian, 11.1% Hispanic; 75.5% college degree or higher). Multivariable linear regression examined correlates of COVID-19 vaccine hesitancy (index score of willingness and likelihood of being vaccinated), including sociopolitical factors (MSA, political orientation, COVID-related news exposure), COVID-19 symptoms and testing, mental health (e.g., COVID-related stress), and sociodemographics. 45.3% were “extremely willing” to get the vaccine (19.8% very, 14.2% somewhat, 3.7% don’t know, 7.0% a little, 10.1% not at all); 40.2% were “extremely likely” to get vaccinated (22.1% very, 14.2% somewhat, 5.2% don’t know, 7.9% a little, 10.3% not at all). Greater vaccine hesitancy was significantly related to living in specific MSAs (i.e., Atlanta, Oklahoma City, San Diego, Seattle vs. Minneapolis or Boston), identifying as Republican or “no lean” (vs. Democrat), and reporting less COVID-related news exposure and less COVID-related stress, as well as identifying as older, female, Black or other race, having less (vs. greater) than a college education, being married/cohabitating, and having children in the home. Interventions to improve COVID-19 vaccine uptake among hesitant young adults should include communication that address concerns, particularly among women, minority groups, and those from certain geographic regions and/or differing political orientations, and require identifying communication channels that appeal to these groups.

Sociopolitical, mental health, and sociodemographic correlates of COVID-19 vaccine hesitancy among young adults in 6 US metropolitan areas

Coronaviruses (CoVs) are enveloped RNA viruses that infect birds, mammals, and humans. Infections caused by human coronaviruses (hCoVs) are mostly associated with the respiratory, enteric, and nervous systems. The hCoVs only occasionally induce lower respiratory tract disease, including bronchitis, bronchiolitis, and pneumonia. In 2002 to 2003, a global outbreak of severe acute respiratory syndrome (SARS) was the seminal detection of a novel CoV (SARS-CoV). A decade later (June 2012), another novel CoV was implicated as the cause of Middle East respiratory syndrome (MERS) in Saudi Arabia. Although bats might serve as a reservoir of MERS-CoV, it is unlikely that they are the direct source for most human cases. Severe lines of evidence suggest that dromedary camels have been the major cause of transmission to humans. The emergence of MERS-CoV has triggered serious concerns about the potential for a widespread outbreak. All MERS cases were linked directly or indirectly to the Middle East region including Saudi Arabia, Jordan, Qatar, Oman, Kuwait, and UAE. MERS cases have also been reported in the later phases in the United Kingdom, France, Germany, Italy, Spain, and Tunisia. Most of these MERS cases were linked with the Middle East. The high mortality rates in family-based and hospital-based outbreaks were reported among patients with comorbidities such as diabetes and renal failure. MERS-CoV causes an acute, highly lethal pneumonia and renal dysfunction. The major complications reported in fatal cases are hyperkalemia with associated ventricular tachycardia, disseminated intravascular coagulation, pericarditis, and multiorgan failure. The case-fatality rate seems to be higher for MERS-CoV (around 30%) than for SARS-CoV (9.6%). The combination regimen of type 1 interferon + lopinavir/ritonavir is considered as the first-line therapy for MERS. Antiviral treatment is generally recommended for 10 to 14 days in patients with MERS-CoV infection. Convalescent plasma therapy has shown some efficacy among patients refractory to antiviral drugs if administered within 2 weeks of the onset of the disease.

Middle East Respiratory Syndrome Virus Pathogenesis

INTRODUCTION: During a pandemic, there are many situations in which the first available vaccines may not have as high of an effectiveness as vaccines that are still under development or are not yet ready for distribution, raising the question of whether it is better to go with what is available now or wait. METHODS: In 2020, the team developed a computational model that represents the U.S. population, coronavirus disease 2019 (COVID-19) spread, and vaccines with different possible efficacies (to prevent infection or reduce severe disease) and vaccination timings to estimate the clinical and economic value of vaccination. RESULTS: Except for a limited number of situations, mainly early on in a pandemic and for a vaccine that prevents infection, when an initial vaccine is available, waiting for a vaccine with a higher efficacy results in additional hospitalizations and costs over the course of the pandemic. For example, if a vaccine with a 50% efficacy in preventing infection becomes available when 10% of the population has already been infected, waiting until 40% are infected for a vaccine with 80% efficacy in preventing infection results in 15.6 million additional cases and 1.5 million additional hospitalizations, costing $20.6 billion more in direct medical costs and $12.4 billion more in productivity losses. CONCLUSIONS: This study shows that there are relatively few situations in which it is worth foregoing the first COVID-19 vaccine available in favor of a vaccine that becomes available later on in the pandemic, even if the latter vaccine has a substantially higher efficacy.

The Benefits of Vaccinating With the First Available COVID-19 Coronavirus Vaccine

BACKGROUND: The delta smelt (Hypomesus transpacificus) is a pelagic fish species listed as endangered under both the USA Federal and Californian State Endangered Species Acts and considered an indicator of ecosystem health in its habitat range, which is limited to the Sacramento-San Joaquin estuary in California, USA. Anthropogenic contaminants are one of multiple stressors affecting this system, and among them, current-use insecticides are of major concern. Interrogative tools are required to successfully monitor effects of contaminants on the delta smelt, and to research potential causes of population decline in this species. We have created a microarray to investigate genome-wide effects of potentially causative stressors, and applied this tool to assess effects of the pyrethroid insecticide esfenvalerate on larval delta smelt. Selected genes were further investigated as molecular biomarkers using quantitative PCR analyses. RESULTS: Exposure to esfenvalerate affected swimming behavior of larval delta smelt at concentrations as low as 0.0625 μg.L(-1), and significant differences in expression were measured in genes involved in neuromuscular activity. Alterations in the expression of genes associated with immune responses, along with apoptosis, redox, osmotic stress, detoxification, and growth and development appear to have been invoked by esfenvalerate exposure. Swimming impairment correlated significantly with expression of aspartoacylase (ASPA), an enzyme involved in brain cell function and associated with numerous human diseases. Selected genes were investigated for their use as molecular biomarkers, and strong links were determined between measured downregulation in ASPA and observed behavioral responses in fish exposed to environmentally relevant pyrethroid concentrations. CONCLUSIONS: The results of this study show that microarray technology is a useful approach in screening for, and generation of molecular biomarkers in endangered, non-model organisms, identifying specific genes that can be directly linked with sublethal toxicological endpoints; such as changes in expression levels of neuromuscular genes resulting in measurable swimming impairments. The developed microarrays were successfully applied on larval fish exposed to esfenvalerate, a known contaminant of the Sacramento-San Joaquin estuary, and has permitted the identification of specific biomarkers which could provide insight into the factors contributing to delta smelt population decline.

Linking mechanistic and behavioral responses to sublethal esfenvalerate exposure in the endangered delta smelt; Hypomesus transpacificus (Fam. Osmeridae)

BACKGROUND: To allow better allocation of staff and resources, rapid response teams attending to acutely deteriorating or aggressive patients with suspected or confirmed COVID-19 infection were pre-warned with the announcement of 'Code-95' with calls. AIM: To assess healthcare worker (HCW) perspectives on pre-warning rapid response calls (RRC) with 'Code-95' in announcements when attending to deteriorating or aggressive patients with suspected/confirmed COVID-19 infection. METHODS: Design: prospective cross-sectional single-centre survey of HCW over a 3-week period. SETTING: tertiary public hospital. PARTICIPANTS: HCW caring for deteriorating or aggressive patients. MAIN OUTCOME MEASURES: the primary outcome was to assess HCW perspectives in attending Code-95 calls. Secondary outcomes were to identify any differences related to craft group, age, experience or presence of comorbidities. RESULTS: A total of 297 responses was analysed; 86.7% of HCW (n = 257) attending Code-95 calls reported anxiety. Medical staff reported greater anxiety in comparison to nursing staff (93.8% vs 78.5%; P = 0.002). Efferent team reported higher anxiety in contrast to afferent team (92.6% vs 58.8%; P = 0.021). There was no significant difference in perceived anxiety based on age (&#8804;40 vs >40 years of age), years of experience (&#8804;5 vs >5 years), comorbidities or mental illness; 54% reported concerns about adequacy of infection-control policies and personal protective equipment; 45% were worried about inadequate training for responding to Code-95 calls. CONCLUSIONS: Most surveyed HCW supported Code-95 announcements pre-warning them of potential COVID-19 exposure when attending a RRC. However, the majority of HCW reported anxiety when attending these calls. Medical and efferent team HCW perceived greater anxiety compared to nursing and afferent team HCW. The Code-95 system to pre-warn rapid response teams may be a useful addition to protecting HCW from infectious diseases, although broader implementation will require greater resourcing, training and support.

'Code-95' rapid response calls for patients under airborne precautions in the COVID-19-era: a cross-sectional survey of healthcare worker perceptions

The Nef gene product is a regulatory protein of HIV whose biological function is poorly understood. Nef has been thought to have a negative effect on viral replication in vitro but has been shown in studies with SIV to be necessary in the establishment of viraemia in vivo. In vitro studies in various human cell lines have shown that Nef downregulates the expression of cell surface CD4 and thus could have effects on the immune response. We have generated four transgenic mouse lines, with constructs containing two different Nef alleles under the control of CD2 regulatory elements to examine the interaction of Nef with the host immune system in vivo. In adult transgenic mice we have found marked downregulation in the level of CD4 on the surface of double positive thymocytes and a decrease in the number of CD4+ T cells in the thymus. Functional analyses have revealed a decrease in the total activation of transgenic thymocytes by anti-CD3 epsilon antibody. By specific intracellular staining of T cells in such mice we have found CD4 colocalizing with a Golgi-specific marker. These results strongly suggest a Nef mediated effect on developing CD4 thymocytes resulting from interference of Nef in the intracellular trafficking or post-translational modification of CD4.

CD4 cell surface downregulation in HIV-1 Nef transgenic mice is a consequence of intracellular sequestration.

None.

Adequate measures to prevent medical personnel from contracting COVID-19 should be promptly implemented: support from numerous agencies is needed.

Background: The coronavirus disease 2019 (COVID-19) pandemic is the largest acute public health emergency of this century Government intervention to contain the virus focuses on non-pharmacological approaches such as physical distancing/lockdown (stay-at-home orders) As the situation develops, the impact of these measures on mental health and coping strategies in individuals and the population is unknown Methods: We used Google Trends data (01 Jan 2020 to 09 Jun 2020) to explore the changing pattern of public concern in the UK to government measures as indexed by changes in search frequency for topics related to mental distress as well as coping and resilience We explored the changes of specific topics in relation to key dates during the pandemic In addition, we examined terms whose search frequency increased most Results: Following lockdown, public concerns - as indexed by relative search trends - were directly related to COVID-19 and practicalities such as ‘furlough’ (paid leave scheme for people in employment) in response to the pandemic Over time, searches with the most substantial growth were no longer directly or indirectly related to COVID-19 In contrast to relatively stable rates of searches related to mental distress, the topics that demonstrated a sustained increase were those associated with coping and resilience such as exercise and learning new skills Conclusions: Google Trends is an expansive dataset which enables the investigation of population-level search activity as a proxy for public concerns It has potential to enable policy makers to respond in real time to promote adaptive behaviours and deliver appropriate support

Tracking online searches for emotional wellbeing concerns and coping strategies in the UK during the COVID-19 pandemic: a Google Trends analysis [version 1;peer review: awaiting peer review]

The receptor binding domain (RBD) of the SARS-CoV-2 spike protein is the primary target of neutralizing antibodies and is a component of almost all vaccine candidates. Here, RBD immunogens were created with stabilizing amino acid changes that improve the neutralizing antibody response, as well as characteristics for production, storage, and distribution. A computational design and in vitro screening platform identified three improved immunogens, each with approximately nine amino acid changes relative to the native RBD sequence and four key changes conserved between immunogens. The changes are adaptable to all vaccine platforms, are compatible with established changes in SARS-CoV-2 vaccines, and are compatible with mutations in emerging variants of concern. The immunogens elicit higher levels of neutralizing antibodies than native RBD, focus the immune response to structured neutralizing epitopes, and have increased production yields and thermostability. Incorporating these variant-independent amino acid changes in next-generation vaccines may enhance the neutralizing antibody response and lead to pan-SARS-CoV-2 protection.

Design of the SARS-CoV-2 RBD vaccine antigen improves neutralizing antibody response

Background: In Kuwait, as in much of the world, COVID-19 epidemic has been spreading since February 2020 The government of Kuwait has taken several measures to minimize virus spread The epidemic and measures to contain it will likely psychologically influence individuals This study investigated the prevalence of anxiety and depression symptoms in Kuwaiti nationals and expats The study’s secondary aim was to identify the association between sociodemographic characteristics and physical activity (PA) engagement, with psychological disorders such as anxiety and depression during the COVID-19 pandemic in Kuwait A two-section survey was used to examine sociodemographic characteristics and PA engagement, and generalized anxiety (GAD-7) and depression symptoms (PHQ-9) Results: Results of this study indicated that 53 7% and 59 6% of the respondents experienced anxiety and depression The multiple regression models significantly predicted anxiety and depression (P &lt; 0 001) In addition, PA, gender, education, and age were significantly associated with anxiety (P &lt; 05), while PA, gender, age, and marital status were significantly associated with depression (P &lt; 05) Conclusions: Findings suggest that the COVID-19 outbreak may have a greater psychological impact on women, younger individuals, married people, and individuals with a bachelor’s degree However, regular PA appears to be an important immediate and long-term factor in reducing symptoms of anxiety and depression during an epidemic © 2020, The Author(s)

Anxiety and depression during the COVID-19 pandemic in Kuwait: the importance of physical activity

There is considerable enthusiasm about the prospect that artificial intelligence (AI) will help to improve the safety and efficacy of health services and the efficiency of health systems. To realize this potential, however, AI systems will have to overcome structural problems in the culture and practice of medicine and the organization of health systems that impact the data from which AI models are built, the environments into which they will be deployed, and the practices and incentives that structure their development. This perspective elaborates on some of these structural challenges and provides recommendations to address potential shortcomings.

Artificial intelligence in medicine: Overcoming or recapitulating structural challenges to improving patient care?

INTRODUCTION: Hepatic steatosis is associated with cardiac systolic and diastolic dysfunction. Therefore, we evaluated metabolites and their potential cardiovascular effects in metabolic-dysfunction-associated fatty liver disease (MAFLD). MATERIALS AND METHODS: We conducted a cross-sectional study involving 75 participants (38 MAFLD and 37 controls). Hepatic steatosis was confirmed by hepatic ultrasonography and SteatoTest(TM). Cardiac function was assessed using echocardiography. Metabolomic analysis was conducted using ultra-high-performance liquid chromatography–mass spectrometry. RESULTS: The median age for participants’ age was 45 (IQR 30–56.5), with gender distribution of 35 males and 40 females. MAFLD patients had lower levels of glycyl tyrosine (p-value < 0.001), lysophosphatidylcholine (LPC) (18:2/0:0) (p-value < 0.001), LPC (22:6) (p-value < 0.001), and ceramide (Cer) (d18:0/23:0) (p-value 0.003) compared to controls. MAFLD patients presented lower left ventricular ejection fraction (LVEF), E/A ratio, E/e′ ratio, and average global longitudinal strain (GLS) values, with a p-value of 0.047, <0.001, 0.008, and <0.001, respectively. Decreased glycyl tyrosine levels were significantly correlated with reduced LVEF, even after performing multiple linear regression with 95% CI (1.34–3.394, p-value < 0.001). Moreover, decreased LPC (18:2/0:0) levels remained significantly associated with E/A ratio, even after adjusting for confounding factors with 95% CI (0.008–0.258, p-value = 0.042). CONCLUSION: MAFLD patients are at risk for developing cardiac systolic and subclinical systolic dysfunctions, as well as diastolic dysfunction. Decreased glycyl tyrosine levels correlate with reduced LVEF and LPC (18:2/0:0) levels with diastolic dysfunction, even after adjusting for confounding factors, suggesting their potential to be used as metabolic biomarkers in detecting cardiovascular risk.

Metabolic biomarkers related to cardiac dysfunction in metabolic-dysfunction-associated fatty liver disease: a cross-sectional analysis

Abstract In this review, we present some ethical imperatives observed in this pandemic from a data ethics perspective Our exposition connects recurrent ethical problems in the discipline, such as, privacy, surveillance, transparency, accountability, and trust, to broader societal concerns about equality, discrimination, and justice We acknowledge data ethic’s role as significant to develop technological, inclusive, and pluralist societies

The ethical imperatives of the COVID-19 pandemic: A review from data ethics

Exercise prescription based on exercise test results is complicated by the need to downregulate the absolute training intensity to account for cardiovascular drift in order to achieve a desired internal training load. We tested a recently developed generalized model to perform this downregulation using metabolic equivalents (METs) during exercise testing and training. A total of 20 healthy volunteers performed an exercise test to define the METs at 60, 70, and 80% of the heart rate (HR) reserve and then performed randomly ordered 30 min training bouts at absolute intensities predicted by the model to achieve these levels of training intensity. The training HR at 60 and 70% HR reserve, but not 80%, was significantly less than predicted from the exercise test, although the differences were small. None of the ratings of perceived exertion (RPE) values during training were significantly different than predicted. There was a strong overall correlation between predicted and observed HR (r = 0.88) and RPE (r = 0.52), with 92% of HR values within ±10 bpm and 74% of RPE values within ±1 au. We conclude that the generalized functional translation model is generally adequate to allow the generation of early absolute training loads that lead to desired internal training loads.

Functional Translation of Exercise Responses from Exercise Testing to Exercise Training: The Test of a Model

Case 1 A 20-month-old boy is brought to his family practitioner by his mother. The boy has a 12-hour history of a loud cough, slight fever to 101°F, and a hoarse voice. The mother reports that the child had a difficult time sleeping the previous night because of the harsh cough. On examination, the boy is playful and smiling with a temperature of 99°F. It is noticed that he has a seal-like barking cough and subtle evidence of audible stridor.His chest is clear on auscultation with a normal respiratory rate.No chest wall recession is noted. The rest of the exam is unremarkable. The patient is sent home with a suspected upper respiratory infection. Later that evening, the family practitioner receives a phone call from the emergency department informing him that the patient has had worsening respiratory difficulty with visible signs of inspiratory stridor and is being admitted to the hospital for further observation.

Croup

Objective To describe the experience of COVID-19 disease among chronically ventilated and non-ventilated nursing home patients living in three separate nursing homes. Design Observational study of death, respiratory illness and COVID-19 polymerase chain reaction (PCR) results among residents and staff during nursing home outbreaks in 2020. Setting and Participants 93 chronically ventilated nursing home patients and 1151 non-ventilated patients living among three separate nursing homes on Long Island, New York as of March 15, 2020. Illness, PCR results, and antibody studies among staff are also reported. Measurements Death rate among chronically ventilated and non-ventilated patients between March 15 and May 15, 2020 compared to the same time in 2019. Prevalence of PCR positivity among ventilated and non-ventilated patients in 2020. Reported illness, PCR positivity and antibody among staff. Results Total numbers of deaths among chronically ventilated nursing home patients during this timeframe were similar to the analogous period 1 year earlier (9 of 93 in 2020 versus 8 of 100 in 2019 p=0.8) whereas deaths among non-ventilated patients were greatly increased (214 of 1151 in 2020 versus 55 of 1189 in 2019, p<0.0001). No ventilated patient deaths were clinically judged to be COVID-19 related. No clusters of COVID-19 illness could be demonstrated among ventilated patients. Surveillance PCR testing of ventilator patients failed to reveal COVID-19 positivity (none of 84 ventilator patients versus 81 of 971 non-ventilator patients, p=0.0002). Illness and evidence of COVID-19 infection was demonstrated among staff working both in non-ventilator and in ventilator units. Conclusions and Implications COVID-19 infection resulted in illness and death among non-ventilated nursing home residents as well as among staff. This was not observed among chronically ventilated patients. The mechanics of chronic ventilation appears to protect chronically ventilated patients from COVID-19 disease.

Absence of COVID-19 Disease Among Chronically Ventilated Nursing Home Patients.

BACKGROUND: Mastoid surgery is an aerosol-generating procedure that involves the use of a high-speed drill, which produces a mixture of water, bone, blood and tissue that may contain the viable coronavirus disease 2019 pathogen. This potentially puts the surgeon and other operating theatre personnel at risk of acquiring the severe acute respiratory syndrome coronavirus-2 from contact with droplets or aerosols. The use of an additional drape designed to limit the spread of droplets and aerosols has been described; such drapes include the ‘Southampton Tent’ and ‘OtoTent’. OBJECTIVES: To evaluate the use of a novel drape ‘tent’ that has advantages over established ‘tent’ designs in terms of having: (1) a CE marking; (2) no requirement for modification during assembly; and (3) no obstruction to the surgical visual field. RESULTS AND CONCLUSION: During mastoid surgery, the dispersion of macroscopic droplets and other particulate matter was confined within the novel drape ‘tent’. Use of this drape ‘tent’ had no adverse effects upon the surgeon's manual dexterity or efficiency, the view of the surgical field, or the sterility. Hence, our findings support its use during mastoid surgery in the coronavirus disease 2019 era.

Use of a novel drape ‘tent’ as an infection prevention control measure for mastoid surgery

OBJECTIVE: Due to the quarantine measures during the outbreak of COVID-19, medical schools in China had to shift to online education overnight. Researchers wanted to survey the online medical education status quo and find out the underlying challenges and probable solutions in terms of online medical education to better understand improving and developing medical education in China. METHODS: Researchers distributed self-administered and piloted surveys regarding the implementation of online medical education on WeChat and Wenjuanxing. Researchers distributed three phases of online surveys to the undergraduate medical students, and one online survey to the medical teachers on phase three. RESULTS: Online medical education was carried out smoothly in China. Seventy-six percent of the students were satisfied with online medical education, and it hardly changed after a month. Courses with the quiz and live-stream courses were rare compared with courses incorporated with other elements. Most parents would remind their children to study online at home. At first, the biggest challenge of learning online was the lagging platform. Nevertheless, as time went by, the major challenge became the learning motivation. Most students thought it necessary to re-teach face-to-face after online education, while most teachers did not think so. CONCLUSION: Generally speaking, online medical education was satisfying for both students and teachers, although online courses’ diversity with different forms and elements could be enhanced. Infrastructure construction should be considered first for the schools intended to promote online medical education. If the infrastructure were ready, learning motivation would become the biggest challenge for online medical education. Online medical education efficacy evaluation tools need to be developed in the future to narrow the discrepancy of the evaluation between teachers and students.

Students’ and Teachers’ Perspective on the Implementation of Online Medical Education in China: A Qualitative Study

Here we report the development of a more-sensitive immunoassay for severe acute respiratory syndrome (SARS) based on an enzyme-linked immunosorbent assay using chemiluminescence (CLEIA) to detect the viral nucleocapsid (N) antigen in nasopharyngeal aspirate (NPA) from patients infected with SARS coronavirus (CoV). The CLEIA was established with an optical combination of monoclonal antibodies (MAbs) against SARS CoV N protein prepared from mice immunized with recombinant N protein without cultivating the virus. The capture and detecting MAbs of the CLEIA reacted to the carboxyl-terminal and amino-terminal peptides of the N protein, respectively. The CLEIA was capable of detecting recombinant N protein at 1.56 pg/ml and viral N protein in SARS CoV cell culture lysates at 0.087 of 50% tissue culture infective doses/ml. The CLEIA showed no cross-reactivities to recombinant N proteins of common human CoV (229E, OC43, and NL63) or lysates of cells infected with 229E and OC43. In addition, an evaluation with 18 SARS-positive NPA samples, all confirmed SARS positive by quantitative PCR and antibodies to SARS CoV, revealed that all (18/18) were found positive by the CLEIA; thus, the sensitivity of detection was 100%. When we tested 20 SARS-negative NPA samples, the CLEIA was shown to have high specificity (100%). The sensitivity of our novel SARS CLEIA was significantly higher than the previous EIA and comparable to the other methods using reverse transcription-PCR.

Sensitive and specific enzyme-linked immunosorbent assay using chemiluminescence for detection of severe acute respiratory syndrome viral infection.

Thoracal sympatectomy for hyperhidrosis and vasospastic vascular diseases is a rare method of surgical treatment. Three patients (1 male, 2 female; mean age 27.6; between 25 and 30) with palmar hyperhidrosis and/or axillary and dorsal hyperhidrosis who underwent single port thoracoscopic sympatectomy were analysed for age, sex, time of operation room, intraoperative and postoperative complications and length of hospital stay. Mean operating room time was 70 min (between 30 and 120 min). Mean length of hospital stay was 1 day. No postoperative complications were noted. Single incision laparoscopic surgery for hyperhidrosis is a safe method of treatment and an alternative to laparoscopy.

Single incision thoracoscopic sympathectomy for hyperhidrosis.

Background COVID-19 pandemic caused huge decrease of pediatric admissions to Emergency Department (ED), arising concerns about possible delays in diagnosis and treatment of severe disorders Methods Impact of COVID-19 on Pediatric Emergency Room (ICOPER) was a retrospective multicentre observational study including 23 Italian EDs All the children &lt;18 years admitted, between March 9th and May 3rd 2020 stratified by age, priority code, cause of admission and outcome have been included and compared to those admitted in the same period of 2019 Our objectives were to assess the characteristics of pediatric admissions to EDs since COVID-19 outbreak until the end of lockdown, and to describe the features of critical children Findings 16,426 children were admitted in 2020, compared to 55,643 in 2019 (-70·48%) Higher reduction was reported in hospitals without Pediatric Intensive Care Unit (PICU) (-73·38%) than in those with PICU (-64·08%) (P&lt;0·0001) Admissions with low priority decreased more than critical ones (-82·77% vs 44·17% respectively;P&lt;0·0001) Reduction of discharged patients was observed both in hospitals with (-66·50%) and without PICU (-74·65%) (P&lt;0·0001) No difference in the duration of symptoms before admission was reported between 2019 and 2020, with the majority of children accessing within 24 h (55·08% vs 57·28% respectively;P = 0·2344) Interpretation Admissions with low priority decreased significantly more than those with high priority;we suppose that the fear of being infected in hospital maybe overcame the concerns of caregivers Compared to 2019, no significant referral delay by caregivers was reported Our data suggest the need of adaptation of EDs and primary care services to different needs of children during COVID-9 pandemic

Pediatric admissions to emergency departments of North-Western Italy during COVID-19 pandemic: A retrospective observational study

Treatment failures with artemisinin combination therapies (ACTs) threaten global efforts to eradicate malaria. They highlight the importance of identifying drug targets and new inhibitors and of studying how existing antimalarial classes work. Here, we report the successful development of a heterologous expression-based compound-screening tool. The validated drug target Plasmodium falciparum ATPase 6 (PfATP6) and a mammalian orthologue (sarco/endoplasmic reticulum calcium ATPase 1a [SERCA1a]) were functionally expressed in Saccharomyces cerevisiae, providing a robust, sensitive, and specific screening tool. Whole-cell and in vitro assays consistently demonstrated inhibition and labeling of PfATP6 by artemisinins. Mutations in PfATP6 resulted in fitness costs that were ameliorated in the presence of artemisinin derivatives when studied in the yeast model. As previously hypothesized, PfATP6 is a target of artemisinins. Mammalian SERCA1a can be mutated to become more susceptible to artemisinins. The inexpensive, low-technology yeast screening platform has identified unrelated classes of druggable PfATP6 inhibitors. Resistance to artemisinins may depend on mechanisms that can concomitantly address multitargeting by artemisinins and fitness costs of mutations that reduce artemisinin susceptibility.

Selective Inhibition of Plasmodium falciparum ATPase 6 by Artemisinins and Identification of New Classes of Inhibitors after Expression in Yeast

Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection that often results in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). An emerging mechanism of sepsis-induced ARDS involves neutrophils/macrophages undergoing cell death, releasing nuclear histones to cause tissue damage that exacerbates pulmonary injury. While published studies focus on unmodified histones, little is known about the role of citrullinated histone H3 (CitH3) in the pathogenesis of sepsis and ALI. In this study, we found that levels of CitH3 were elevated in the patients with sepsis-induced ARDS and correlated to PaO2/FiO2 in septic patients. Systematic administration of CitH3 peptide in mice provoked Caspase-1 activation in the lung tissue and caused ALI. Neutralization of CitH3 with monoclonal antibody improved survival and attenuated ALI in a mouse sepsis model. Furthermore, we demonstrated that CitH3 induces ALI through activating Caspase-1 dependent inflammasome in bone marrow derived macrophages and bone marrow derived dendritic cells. Our study suggests that CitH3 is an important mediator of inflammation and mortality during sepsis-induced ALI.

Citrullinated Histone H3 Mediates Sepsis-Induced Lung Injury Through Activating Caspase-1 Dependent Inflammasome Pathway

BACKGROUND: School feeding programs are ubiquitous in low- and middle-income countries (LMICs) and may have critical implications for the health and education of school-age children and adolescents. This systematic review aimed to assess the impacts of school feeding on educational and health outcomes of children and adolescents in LMICs. METHODS: Interventional studies on the effects of school feeding on nutritional and health outcomes of children and adolescents receiving primary or secondary education in LMICs were included. MEDLINE, EMBASE, CINAHL, the Cochrane Library, and grey literature were searched (through December 2019) to identify eligible studies. We included randomized controlled trials and controlled before-after studies on school feeding conducted in LMICs among children and adolescents aged 6 to 19 who received primary or secondary education. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment. Meta-analyses were performed for outcomes available in three or more independent studies. Subgroup analyses were conducted by study design and school feeding modality whenever possible. RESULTS: Fifty-seven articles met the inclusion criteria for the review, including 44 randomized controlled trials and 13 controlled before-after studies; 19 articles were included in the meta-analysis. School feeding resulted in a significant increase in height (mean difference = 0.32 cm; confidence interval (CI) = 0.03, 0.61; P = 0.032) and weight (mean difference: 0.58 kg; 95% 95% CI = 0.22, 0.93; P = 0.001) over 12 months, compared to those in the control groups. School feeding also resulted in a significant increase in the percentage of school days attended (2.6%; 95% CI = 1.2%, 3.9%; P < 0.001). CONCLUSIONS: School feeding is an important approach to improving the health and education outcomes of children and adolescents living in LMICs. More well-designed research is needed to establish further the effectiveness of school feeding for nutritional outcomes and academic achievement. REGISTRATION: PROSPERO ID: CRD42020159003.

Impacts of school feeding on educational and health outcomes of school-age children and adolescents in low- and middle-income countries: A systematic review and meta-analysis

INTRODUCTION: Healthcare is increasingly challenged to meet the demands of user involvement and knowledge mobilisation required by the 21st-century patient-centred and knowledge-based economies. Innovations are needed to reduce problematic barriers to knowledge exchange and improve collaborative problem solving. Living labs, as open knowledge systems, have the potential to address these gaps but are underexplored in healthcare. METHODS AND ANALYSIS: We will conduct the first systematic review of living labs across healthcare contexts. We will comprehensively search the following online databases from inception to 31 December 2020: Scopus, the Cochrane Library (Wiley), Medline (OVID), Embase (OVID), Web of Science, PsycINFO (OVID) and EBSCOhost databases including Academic Search Complete, Business Source Premier, Canadian Reference Centre, CINAHL, MasterFILE Premier, SPORTDiscus, Library & Information Science Source, Library, Information Science & Technology Abstracts, AgeLine, EconLit, Art Full Text, Women's Studies International and Social Work Abstracts. We will search for grey literature using Google advanced techniques and books/book chapters through scholarly and bibliographical databases. We will use a dual-reviewer, two-step selection process with pre-established inclusion criteria and limit to English language publications. Empirical studies of any design examining living lab development, implementation or evaluation in health or healthcare will be included. We will use the Mixed Methods Appraisal Tool (MMAT) for methodological quality appraisal and Covidence software for review management, and we will extract data on pre-established variables such as lab context and technological platforms. We will create evidence tables and analyse across variables such as focal aim and achievement of living lab principles, such as the use of cocreation and multimethod approaches. We will tabulate data for descriptive reporting and narrative synthesis to identify current applications, approaches and promising areas for living lab development across health contexts. ETHICS AND DISSEMINATION: Ethical approval was not required for this review. This review will inform research into living labs in health environments, including guidance for a living lab in paediatric rehabilitation. Academic publications shared through collaborative networks and social media channels will provide substantive knowledge to the growing tech-health development sector and to researchers, practitioners and organisations seeking enhanced patient/stakeholder engagement and innovations in knowledge translation and evidence-based practice. PROSPERO REGISTRATION NUMBER: CRD42020175275.

Protocol for a systematic review of living labs in healthcare

BACKGROUND: The current outbreak of SARS-CoV-2 has spread to almost every country with more than three million confirmed cases and over two hundred thousand deaths as of April 28, 2020. Rapid first-line testing protocols are needed for outbreak control and surveillance. METHODS: We used computational and manual design to generate a suitable set of reverse transcription recombinase polymerase amplification (RT-RPA) primer and exonuclease probe, internally quenched (exo-IQ) probe sequences targeting the SARS-CoV-2 N gene. RT-RPA sensitivity was determined by amplification of in vitro transcribed RNA standards. Assay selectivity was demonstrated with a selectivity panel of 32 nucleic acid samples derived from common respiratory viruses. To validate the assay against full-length SARS-CoV-2 RNA, total viral RNA derived from cell culture supernatant and 19 nasopharyngeal swab samples (8 positive and 11 negative for SARS-CoV-2) were screened. All results were compared to established RT-qPCR assays. RESULTS: The 95% detection probability of the RT-RPA assay was determined to be 7.74 (95% CI: 2.87 - 27.39) RNA copies per reaction. The assay showed no cross-reactivity to any other screened coronaviruses or respiratory viruses of clinical significance. The developed RT-RPA assay produced 100% diagnostic sensitivity and specificity when compared to RT-qPCR (n=20). CONCLUSION: With a run time of 15 to 20 minutes and first results being available in under 7 minutes for high RNA concentrations, the reported assay constitutes one of the fastest nucleic acid based detection methods for SARS-CoV-2 to date and may provide a simple to use alternative to RT-qPCR for first-line screening at the point of need.

Rapid detection of SARS-CoV-2 by low volume real-time single tube reverse transcription recombinase polymerase amplification using an exo probe with an internally linked quencher (exo-IQ)

BACKGROUND: The worldwide COVID-19 pandemic is overstressing health systems and Essential health services and vaccination services are disrupted. Immunization is a confirmed gizmo for governing and even eliminating communicable diseases. OBJECTIVE: This study aims to assess the challenge and status of immunization during COVID-19 and associated factors among children aged 10–23 months south Nation Nationality and People Region Ethiopia. Methods and Materials: community-based mixed quantitative and qualitative cross-sectional study was done in southwest Ethiopia. Data was collected using semi-structured questionnaires and in-depth interviews. After that, the data were edited, coded, and move in into Epi info version 7.2 for data management then transported to SPSS version 25 for analysis. The analyzed data were presented by tables, graphs, figures, and text form. RESULTS: According to this study, the prevalence of incomplete immunization was found to be 809 (62.2%) with (95% CI: 59.5, 64.8). In multivariable analysis waiting time at a health facility (AOR=0.04, 95% CI 0.0001,0.004), education (AOR=5.08,95% CI2.31,11.14), place of delivery (AOR=2.34,95% CI 4.96,6.089), fearing of COVID-19 (AOR=3.62,95% CI 1.72,7.64) and do not understand the separation care of COVID-19 and other health services (AOR=2.85,95% CI1.38,5.9) were significantly associated factors. CONCLUSION: The prevalence of incomplete immunization among children aged 10–23 months was very high in this study as compared to the other studies done in a different pocket of Ethiopia. Consecutively, reducing waiting time at a health facility, avoiding unnecessary fear of COVID-19, and promoting immunization in a different area of southwest Ethiopia along with health extension workers are recommended.

Immunization Status and Challenges During COVID-19 and Associated Factors Among Children Aged 10–23 Months in South Region, Ethiopia 2020

Implementation of telemedicine for patient encounters optimizes personal safety and allows for continuity of patient care. Embracing telehealth reduces the use of personal protective equipment and other resources consumed during in-person visits. The use of telehealth has increased to historic levels in response to the coronavirus disease 2019 (COVID-19) pandemic. Telehealth may be a key modality to fight against COVID-19, allowing us to take care of patients, conserve personal protective equipment, and protect health care workers all while minimizing the risk of viral spread. We must not neglect vascular health issues while the coronavirus pandemic continues to flood many hospitals and keep people confined to their homes. Patients are not immune to diseases and illnesses such as stroke, critical limb ischemia, and deep vein thrombosis while being confined to their homes and afraid to visit hospitals. Emerging from the COVID-19 crisis, incorporating telemedicine into routine medical care is transformative. By leveraging digital technology, the authors discuss their experience with the implementation, workflow, coding, and reimbursement issues of telehealth during the COVID-19 era.

Telemedicine platforms and their use in the coronavirus disease-19 era to deliver comprehensive vascular care

INTRODUCTION: Neurosyphilis is a chronic infectious disease caused by Treponema pallidum that can cause a great variety of neuropsychiatric signs and symptoms, which complicates its diagnosis. CASE DESCRIPTION: This case occurred in a 40-year-old man who consulted the Emergency Department because of a convulsion (de novo) which was related to a chronic condition of cognitive impairment and psychosis. The appropriate studies were performed for the diagnosis of neurosyphilis and the recommended treatment was initiated. The patient presented clinical improvement and was discharged. DISCUSSION: Positive VDRL serology results and imaging findings of marked cortical atrophy conducted to consider a late-stage parenchymatous neurosyphilis with serious cognitive impairment and associated psychosis. Treatment with crystalline penicillin was formulated, which reduced the intensity of the patient's symptoms; however, the patient's lack of interest to attend the check-ups significantly reduces his chances of an adequate recovery. CONCLUSIONS: Neurosyphilis must be suspected in patients with clinically evident neurological or psychiatric symptoms. Analysis of VDRL serology and neuroimaging studies are important as an initial evaluation of the patient and must be complemented with cognitive tests or mental examination to determine the state of cognitive impairment.

Trastorno neurocognitivo debido a neurosífilis: informe de un caso./ Trastorno neurocognitivo debido a neurosífilis: informe de un caso./ Neurocognitive disorder due to neurosyphilis: a case report

CD147, a glycosylated transmembrane protein in the immunoglobulin superfamily, is overexpressed on the surfaces of various tumor cells and promotes cancer cell proliferation, invasion, and metastasis. Nanobodies, characterized by small sizes, high affinities and specificities, and low immunogenicities, are promising diagnostic and therapeutic tools. However, there are few reports on nanobodies that specifically target CD147. In this work, a specific anti-CD147 nanobody has been successfully identified using phage display technology. The tumor target and antitumor effects have also been detected in different CD147-positive tumors in in vitro and in vivo assays, respectively. Meanwhile, it has a synergistic effect for inhibiting 4T1-bearing mice through conjugating doxorubicin. It may afford new strategies for cancer therapies.

Generation of a High-Affinity Nanobody Against CD147 for Tumor Targeting and Therapeutic Efficacy Through Conjugating Doxorubicin

The aim of this article is to explore the ways in which the engagement with Greek tragedy may contribute fruitfully to the unfolding of empathy in medical students and practitioners. To reappraise the general view that classical texts are remote from modern experience because of the long distance between the era they represent and today, I propose an approach to Greek tragedy viewed through the lens of historical empathy, and of the association between past situations and similar contemporary experiences, in particular. After a brief examination of the concept of empathy, its links with literary reading, and the discussion of these interrelations within the training of narrative medicine, and narrative ethics in particular, the focus turns to selected parts of Sophocles’ Philoctetes, such as the disease scene—an ancient example of pathography. Here Neoptolemus’ empathy for Philoctetes’ situation and its consequences are explored with specific interest in the modern readers’ affective response in connection with their own experiences in medical practice. Neoptolemus’ ethical conflict, which is resolved by his decision to care for Philoctetes, and the problematic nature of this attitude are both indicative of the aim of Greek tragedy to problematize universal issues and thus to point towards the instability of human life and the fluidity of human nature. Realizing through historical empathy the precariousness of human existence may lead to a better understanding and hence better care for others and open new perspectives in the development of empathy within the context of contemporary medical education and practice.

Historical empathy and medicine: Pathography and empathy in Sophocles’ Philoctetes

COVID-19 mitigation measures present unprecedented challenges in mental healthcare delivery, posing high risk to the mental health of at-risk populations, namely patients diagnosed with COVID-19, frontline healthcare providers, and those submitted to quarantine or isolation measures, as well as the general population. Ensuring safe and equitable access to mental healthcare by these groups entails resorting to innovative psychosocial intervention strategies, such as digital mental health. In this perspective piece, we describe the impact of COVID-19 on the Portuguese population's mental health, present an overview on initiatives developed to address the challenges currently faced by the Portuguese mental healthcare system, and discuss how the timely implementation of a comprehensive digital mental health strategy, coupling research, education, implementation, and quality assessment initiatives, might buffer COVID-19's impact on the Portuguese society.

Mitigating COVID-19 Impact on the Portuguese Population Mental Health: The Opportunity That Lies in Digital Mental Health