We analyze changes in the reproduction number, R, of COVID-19 in response to public health interventions. Our results indicate that public health measures undertaken in China reduced R from 1.5 in January to 0.4 in mid-March 2020. They also suggest, however, the limitations of isolation, quarantine, and large-scale attempts to limit travel. While the world-wide reproduction number briefly dropped below 1 as China implemented extensive public health measures, the introduction of the virus to other nations swiftly led to an increasing world-wide average value of R. In Italy, the nation hardest-hit following China, social distancing measures brought the local value of R down from 3.71 to 2.51. Nonetheless, the value of R in Italy persisted at levels well above 1, allowing for ongoing transmission. By mid-March 2020, as COVID-19 spread in areas without extensive public health interventions in place, the world-wide value of R increased to a level similar to that of late January.

Background: Down Syndrome (DS) is one of the most impacted population to the COVID-19 pandemic.Methods: The markers for demographic profile, clinical symptoms, comorbidities, and the clinical of severe acute respiratory syndrome (SARS)evolution of first year of COVID-19 pandemic in Brazil was obtained from a Brazilian open-access database. The data were compared between (i) individuals with DS and positive for COVID-19 [G1;1,619 (0.4%)] and individuals with SARS due to other etiologic agents [G2;1,431 (0.4%)];(ii) G1 individuals versus individuals with COVID-19, but without DS or comorbidities [G3;222,181 (64.8%)].Findings: Individuals from G1 when compared to G2 were older (25 yo), presented more symptoms related to severe illness and comorbidities, needed more frequently intensive care unit (ICU) treatment as well as noninvasive mechanical ventilation (MV), and presented a nearly 3-fold-increased risk for mortality. Individuals from G1 when compared to G3 were younger (<24 yo), more prone to nosocomial infection, presented increased chance for symptoms related to a more severe illness;needed frequently hospitalization, ICU treatment, or invasive and noninvasive MV, presented almost a 4-fold-increased risk for mortality. Also, the high mortality rate in G1 was associated with oldest age (25 yo), presence of symptoms and sign related to a more severe clinical condition or obesity. The need for hospitalization in G1 was associated to a low mortality rate. On the other hand, individuals who needed ICU treatment and MV presented high mortality rate.Interpretation: Individuals with DS are most affected by COVID-19 and demonstrated particularities regarding comorbidities, clinical signs and symptoms, needed MV regularly, and high mortality rate.Funding: MNB received a grant from FAPESP (Funda??o de Amparo Pesquisa do Estado de S?o Paulo C Acronym for S?o Paulo Research Foundation;#2021/05810-7).Declaration of Interest: None to declare.

Sickle cell disease (SCD) is associated with significant health challenges that often worsen during adolescence. Living with SCD requires a substantial amount of self-management and mobile health (mHealth) holds considerable promise for assessing and changing behaviors to improve health outcomes. We integrated a mobile app as an adjunct to a group intervention (SCThrive) and hypothesized that more engagement with the mHealth app would increase self-management and self-efficacy for adolescents and young adults (AYA) with SCD. Twenty-six AYA ages 13C21 years (54% female; 46% HbSS genotype; all African-American/Black) received six weekly group sessions (three in-person, three online). Participants were provided with the mobile app (iManage for SCD) to record progress on their self-management goals and log pain and mood symptoms. The Transition Readiness Assessment Questionnaire (TRAQ-5) assessed self-management skills and the Patient Activation Measure (PAM-13) assessed self-efficacy at baseline and post-treatment. Logging on to the app more frequently was associated higher mood ratings (r = .54, CI[.18, .77], p = .006) and lower pain ratings (r = ?.48, CI[?.77, ?.02], p = .04). Regression analyses demonstrated that after controlling for scores at baseline, the number of logins to the app predicted self-management skills (p = .05, (2) = .17) and possibly self-efficacy (p = .08, (2) = .13). Our study findings indicate that it can be challenging to maintain engagement in mHealth for AYA with SCD, but for those who do engage, there are significant benefits related to self-management, self-efficacy, and managing pain and mood.

We document two cases of viremic and prolonged active infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) where the viral genome was conserved for two months, but infection was with little or no symptoms. The first infection persisted for 80 days and the second for 62 days. Clearance of infection occurred 40 and 41 days, respectively, after development of detectable antibodies. Both cases were identified incidentally in an investigation of reinfection in a cohort of 133,266 laboratory-confirmed infected persons.

To demonstrate feasibility of acute peritoneal dialysis (PD) for acute kidney injury during the coronavirus disease 2019 (COVID-19) pandemic, we performed a multicenter, retrospective, observational study of 94 patients who received acute PD in New York City in the spring of 2020. Patient comorbidities, severity of disease, laboratory values, kidney replacement therapy, and patient outcomes were recorded. The mean age was 61 11 years; 34% were women; 94% had confirmed COVID-19; 32% required mechanical ventilation on admission. Compared to the levels prior to initiation of kidney replacement therapy, the mean serum potassium level decreased from 5.1 0.9 to 4.5 0.7 mEq/L on PD day 3 and 4.2 0.6 mEq/L on day 7 (P < 0.001 for both); mean serum bicarbonate increased from 20 4 to 21 4 mEq/L on PD day 3 (P = 0.002) and 24 4 mEq/L on day 7 (P < 0.001). After a median follow-up of 30 days, 46% of patients died and 22% had renal recovery. Male sex and mechanical ventilation on admission were significant predictors of mortality. The rapid implementation of an acute PD program was feasible despite resource constraints and can be lifesaving during crises such as the COVID-19 pandemic.

Matrix metalloproteinases (MMPs) cleave extracellular matrix proteins, growth factors, cytokines, and receptors to influence organ development, architecture, function, and the systemic and cell-specific responses to diseases and pharmacological drugs. Conversely, many diseases (such as atherosclerosis, arthritis, bacterial infections (tuberculosis), viral infections (COVID-19), and cancer), cholesterol-lowering drugs (such as statins), and tetracycline-class antibiotics (such as doxycycline) alter MMP activity through transcriptional, translational, and post-translational mechanisms. In this review, we summarize evidence that the aforementioned diseases and drugs exert significant epigenetic pressure on genes encoding MMPs, tissue inhibitors of MMPs, and factors that transcriptionally regulate the expression of MMPs. Our understanding of human pathologies associated with alterations in the proteolytic activity of MMPs must consider that these pathologies and their medicinal treatments may impose epigenetic pressure on the expression of MMP genes. Whether the epigenetic mechanisms affecting the activity of MMPs can be therapeutically targeted warrants further research.

BACKGROUND Research has shown that introducing electronic Health (eHealth) patient monitoring interventions can improve healthcare efficiency and clinical outcomes. The VIGILANCE (VItal siGns monItoring with continuous puLse oximetry And wireless cliNiCian notification aftEr surgery) study was a randomized controlled trial (n=2049) designed to assess the impact of continuous vital sign monitoring with alerts sent to nursing staff when respiratory resuscitations with naloxone, code blues, and intensive care unit transfers occurred in a cohort of postsurgical patients in a ward setting. This report identifies and evaluates key issues and challenges associated with introducing wireless monitoring systems into complex hospital infrastructure during the VIGILANCE eHealth intervention implementation. Potential solutions and suggestions for future implementation research are presented. OBJECTIVE The goals of this study were to: (1) identify issues related to the deployment of the eHealth intervention system of the VIGILANCE study; and (2) evaluate the influence of these issues on intervention adoption. METHODS During the VIGILANCE study, issues affecting the implementation of the eHealth intervention were documented on case report forms, alarm event forms, and a nursing user feedback questionnaire. These data were collated by the research and nursing personnel and submitted to the research coordinator. In this evaluation report, the clinical adoption framework was used as a guide to organize the identified issues and evaluate their impact. RESULTS Using the clinical adoption framework, we identified issues within the framework dimensions of people, organization, and implementation at the meso level, as well as standards and funding issues at the macro level. Key issues included: nursing workflow changes with blank alarm forms (24/1030, 2.33%) and missing alarm forms (236/1030, 22.91%), patient withdrawal (110/1030, 10.68%), wireless network connectivity, false alarms (318/1030, 30.87%), monitor malfunction (36/1030, 3.49%), probe issues (16/1030, 1.55%), and wireless network standards. At the micro level, these issues affected the quality of the service in terms of support provided, the quality of the information yielded by the monitors, and the functionality, reliability, and performance of the monitoring system. As a result, these issues impacted access through the decreased ability of nurses to make complete use of the monitors, impacted care quality of the trial intervention through decreased effectiveness, and impacted productivity through interference in the coordination of care, thus decreasing clinical adoption of the monitoring system. CONCLUSIONS Patient monitoring with eHealth technology in surgical wards has the potential to improve patient outcomes. However, proper planning that includes engagement of front-line nurses, installation of appropriate wireless network infrastructure, and use of comfortable cableless devices is required to maximize the potential of eHealth monitoring. TRIAL REGISTRATION ClinicalTrials.gov NCT02907255; https://clinicaltrials.gov/ct2/show/NCT02907255.

As more cancer patients survive into post-treatment, the challenge of managing their survivorship care is confronting health care systems globally. In striving to deliver high quality survivorship care, equity constitutes a particularly troublesome challenge. We analyzed accounts from both cancer survivors and stakeholders within care system management to uncover insights with respect to barriers to equitable cancer survivorship services. Beyond the social determinants of health that shape inequities across all of our systems, the cancer care system involves a pattern of prioritizing biomedicine, evidence-based options, and care standardization. We learned that these lead to system rigidities that not only compromise the individualization essential to person-centered care but also obscure the attention to group differences that becomes indispensable to responsiveness to inequities. On the basis of these insights, we reflect on what may be required to begin to redress the current and projected inequities with respect to access to appropriate cancer survivorship supports and services.

Objective: Hypertension is commonly accompanied by many comorbidities that are major determinant factors for the severity of COVID-19 To investigate Comorbidities factors and hypertension in relation to COVID-19 Design and method: A retrospective analysis that independent factors in hospitalized patients with COVID 19 Results: A study consisting of 164 COVID 19 patients with hypertension and comorbidities factors (HTCOB) was higher severity and complications in the 49 cases than in the 115 cases with only hypertension cases Chest computed tomographic scans showed bilateral patchy shadows or ground glass opacity in the lungs of 14 COB patients The median time from first symptom to dyspnea was 5 days, to hospital admission was 21 days in the HTCOB Multivariable-adjusted analysis revealed that male sex, age over 60 years old, obesity and hypertension were independent factors for COVID 19 severity Adjustment for age, high lactate dehydrogenase (LDH), and D dimer, hypertension with obesity was independently associated with the severity of COVID 19 on admission Conclusions: There patients with both obesity and hypertension are at particularly high risk for severe disease in COVID-19 and thus require careful observation and intensive treatment

The aim of this study was to establish a method for sensitive and rapid diagnosis of Mycoplasma hyopneumoniae in clinical specimens. To this effect, we employed three sets of primers specifically designed for amplification of nucleic acids under isothermal conditions. After optimization of reaction conditions, M. hyopneumoniae could be successfully detected at 63C in 45 min through use of the loop-mediated isothermal amplification (LAMP) assay. A positive reaction was identified visually as white precipitate and confirmed by gel electrophoresis. The detection limit for this assay was 10 copies/L, as observed by electrophoretic analysis. The accuracy of the LAMP reaction was confirmed by restriction endonuclease digestion as well as by direct sequencing of the amplified product. This method can specifically detect M. hyopneumoniae; other species with high homology and other bacterial and virus strains gave negative results. To test the utility of this procedure, the LAMP assay was applied to 40 clinical samples collected from swine lung tissues experimentally challenged with M. hyopneumoniae isolates, and compared to the results from a real-time polymerase chain reaction (PCR) assay. A concordance of 100% was observed between the two assays. In conclusion, the results from our study demonstrated that the LAMP assay provided a rapid reaction and was inexpensive to perform, with no need of complex instruments or systems such as Geneamp PCR. The LAMP assay may therefore be applied in routine diagnosis in the clinical laboratory and for in-field detection of M. hyopneumoniae infection.

Background: Globe pandemic of COVID-19 endangers the frontline healthcare workers in 2020 To our knowledge, no studies about the HCWs in a field hospital speci

In the absence of a vaccine or cure, prevention remains the most effective strategy against HIV. In this chapter, a variety of the prevention tools available to, and utilised by, gay men are reviewed. The long-standing policy of condom use is discussed, and the potential shortcomings of a prevention policy based exclusively on condom use are outlined. This chapter also considers alternative prevention approaches deployed by some gay men, such as serosorting and strategic sexual positioning. The importance of both HIV and STI testing as part of effective HIV prevention is illustrated. Furthermore, key developments in HIV prevention, such as post-exposure prophylaxis, pre-exposure prophylaxis and treatment as prevention, are examined. Emerging prevention approaches, such as the use of microbicides and male circumcision, as well as the quest for an HIV vaccine are outlined. In this chapter, it is argued that all of these approaches have merits, that none is without its shortcomings and, therefore, that combination prevention is key to eliminating HIV transmissions.

The SARS-CoV-2 virus, caused a novel emerged coronavirus disease, is growing rapidly worldwide. Few studies have evaluated the efficacy and safety of Chloroquine (CQ), an old antimalarial drug, and Hydroxychloroquine (HCQ) in the treatment of COVID-19 infection. HCQ is derived from CQ by adding a hydroxyl group into it and is a less toxic derivative of CQ for the treatment of COVID-19 infection because it is more soluble. This article summarizes pharmacokinetic properties and toxicity considerations for CQ and HCQ, drug interactions, and their potential efficacy against COVID-19. The authors also look at the biochemistry changes and clinical uses of CQ and HCQ, and supportive treatments following toxicity occurs. It was believed that CQ and HCQ may provide few benefits to COVID-19 patients. A number of factors should be considered to keep the drug safe, such as dose, in vivo animal toxicological findings, and gathering of metabolites in plasma and/or tissues. The main conclusion of this review is that CQ and HCQ with considered to their ADMET properties has major shortcomings and fully irresponsible.

Following COVID-19, there has been increasing concern about the well-being of children and young people across the United Kingdom; however, our major problem is the lack of robust data. We discuss emerging research capturing the impact of restrictions and experiences of COVID-19 on children and young people. We suggest further and more detailed analysis is urgently required to inform an evidence-based response. We conclude that although most of the UK's kids are probably OK, it is essential that those who are in need of support receive timely and informed intervention.

In this paper, an Ensemble of Kalman filter (EnKf) approach is developed to estimate unmeasurable state variables and unknown parameters in a COVID-19 model. We first formulate a mathematical model for the dynamic transmission of COVID-19 that takes into account the circulation of free coronaviruses in the environment. We provide the basic properties of the model and compute the basic reproduction number [Formula: see text] that plays an important role in the outcome of the disease. After, assuming continuous measurement of newly COVID-19 reported cases, deceased and recovered individuals, the EnKf approach is used to estimate the unmeasured variables and unknown COVID-19 transmission rates using real data of the current COVID-19 pandemic in Cameroon. We present the forecasts of the current pandemic in Cameroon and explore the impact of non-pharmaceutical interventions such as mass media-based sensitization, social distancing, face-mask wearing, contact tracing and the desinfection and decontamination of infected places by using suitable products against free coronaviruses in the environment in order to reduce the spread of the disease. Through numerical simulations, we find that at that time (i) [Formula: see text] meaning that the disease will not die out without any control measures, (ii) the infection from COVID-19 infected cases is more important than the infection from free coronaviruses in the environment, (iii) the number of new COVID-19 cases will still increase and there is a necessity to increase timely the surveillance by using contact tracing and sensibilisation of the population to respect social distancing, face-masks wearing through awareness programs and (iv) the eradication of the pandemic is highly dependent on the control measures taken by governments.

Since the start of the COVID-19 outbreak, more than four million people have died of this disease. Given its ability to provide a precise response, mass spectrometry-based proteomics could represent a useful tool to study this pathology. To this end, an untargeted nLC-ESI-MS/MS-based method to characterise SARS-CoV-2 proteins, including possible variants, and investigate human saliva and plasma proteome in a single analysis was developed for further application in patients. Four SARS-CoV-2 recombinant proteins, three (S1CS2CRBD) belonging to the spike glycoprotein (S) and one corresponding to the nucleoprotein (N), were prepared and analysed with nLC-UHRTOF by injecting decreasing amounts to establish the limit of detection (LOD) of the method. This was determined as 10 pg for all the components of the S protein and for N (71 amol and 213 amol, respectively). Various viral inactivation strategies plus deglycosylation and digestion approaches were then tested in saliva and plasma spiked with different quantities of SARS-CoV-2 recombinant proteins. The limit of characterisation (LOC) in saliva for the N and S proteins was observed at 100 pg (coverage of 20% and 3%, respectively);instead, in plasma, it was 33 pg for N and 330 pg for the S protein, with a coverage of 4% for both. About 300 and 800 human proteins were identified in plasma and saliva, respectively, including several key effectors and pathways that are known to be altered in COVID-19 patients. In conclusion, this approach allows SARS-CoV-2 proteins and the human proteome to be simultaneously explored, both for plasma and saliva, showing a high relevant potential for retrospective studies aimed at investigating possible virus variants and for patient stratification.

Abstract Background: Stress urinary incontinence (SUI) in females is a common gynecological issue that impedes lifestyle. Exercise had a significant effect; however, studies did not determine the exercise frequency and intensity for pelvic floor stabilization in stress urinary incontinence. Aim: The aim of the study is to determine if maximum repetition of pelvic stabilization exercise impacts the management of stress urinary incontinence in females. Methodology: One arm quasi-experimental study design was used. 40 patients having SUI and associated musculoskeletal complaints were recruited from the outpatient unit of Physiotherapy department of the Centre for the Rehabilitation of the Paralysed (CRP), Bangladesh. The study was conducted over 4weeks. Outcome measurement was included pelvic floor and abdominal muscle strength, endurance, and incontinence measurement. Result: Pelvic floor muscle and abdominal strength, and endurance had a positive and significant result in maximum repetition (P .001). Pelvic floor strength has been significantly improvement in week 2 (P .001), and week 3 (P .01). Interference in activities (P .003), and ICIQ total (P .001) had improvement but majority of the improvement was noted in weeks 2-3. There was a significant improvement in the frequency of urine leakage in the first week (P .001), and week 3 (P .005) and week 4 (P .001). Conclusion: Pelvic floor exercise with increasing repetition is an effective approach to improve stress urinary incontinence in females. The study had a significant impact on incontinence frequency, amount, and associated quality of life for women with stress urinary incontinence with pelvic floor exercise with maximum repetition. Key Words: Stress Urinary Incontinence, Physiotherapy, exercise, Maximum repetition

PURPOSE To investigate the hypothesis that four-dimensional (4D) transcatheter intraarterial perfusion (TRIP) magnetic resonance imaging (MRI) can quantify immediate perfusion changes after radiofrequency (RF) ablation in rabbit VX2 liver tumors. MATERIALS AND METHODS Nine New Zealand White rabbits were used to surgically implant VX2 liver tumors. During ultrasound-guided RF ablation, tumors received either a true or sham ablation. After selective catheterization of the left hepatic artery under x-ray fluoroscopy, we acquired pre- and post-RF ablation 4D TRIP MR images using 3 mL of 2.5% intraarterial gadopentetate dimeglumine. Two regions-of-interest were drawn upon each tumor to generate signal-intensity time curves. Area under the curve (AUC) was calculated to provide semiquantitative perfusion measurements that were compared using a paired t-test ( = 0.05). Ablated tissue was visually confirmed on pathology using Evans blue dye. RESULTS Mean AUC perfusion of VX2 tumors for the true ablation group decreased by 92.0% (95% confidence interval [CI]: 83.3%-100%), from 1913 (95% CI: 1557, 2269) before RF ablation to 76.6 (95% CI: 18.4, 134.8) after RF ablation (a.u., P < 0.001). Sham-ablated tumors demonstrated no significant perfusion changes. CONCLUSION 4D TRIP MRI can quantify liver tumor perfusion reductions in VX2 rabbits after RF ablation. This MRI technique can potentially be used to improve tumor response assessment at the time of RF ablation.

Background Little is known about the impact of the coronavirus disease 2019 pandemic on children with attention-deficit hyperkinetic disorder (ADHD). This study aimed to assess the impact of lockdown on children with the ADHD, and their families. Additionally, feasibility of carrying out text message-based intervention was evaluated. Methods An online survey was performed to evaluate the impact of lockdown on children with ADHD and their family members. Additionally, a text message-based intervention was performed over 2 weeks. Along with the text-based intervention, we also provided reading materials and an option of telephonic consultation. Results Of the 80 parents who initially consented to participate, 48 filled the baseline survey, and 41 agreed to receive intervention. Out of 41, 29 filled satisfaction survey. During the lockdown period, there was worsening of symptoms of ADHD in the form of increase (slight or marked) in the activity level (50.1%), irritability (45.8%), and disturbing or disruptive behavior (47.7%) in children. In terms of behavior of family members, there was marked/slight increase in irritability (37.5%), and shouting at the child (43.8%), verbal abuse (25%), and punishing the child (27.1%). Additionally, there was an increase in the praising (67.6%) and spending time with the child (72.9%). Text-based messages on a scale of 0 to 10 were rated as 5.79 for the content, 5.76 for the usefulness, and 6 for satisfaction. Conclusion Lockdown resulted in worsening of symptoms among children of ADHD and it had impact on the interaction pattern of the children and parents. A text message-based intervention is a feasible and possibly acceptable option to deal with the behavioral problem of the children and adolescents with ADHD.

COVID-19 is a contagious disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). As humanity continues to fight this virus, it keeps presenting with new manifestations and complications. Platypnea-orthodeoxia syndrome (POS) is a rare clinical syndrome characterized by dyspnea and oxygen desaturation, in the supine to sitting position, which resolves with recumbency and can be diagnosed with a simple pulse oximeter. We report three cases of COVID-19 pneumonia, who developed POS during the recovery phase, in the absence of pulmonary hypertension.