BACKGROUND: Genetic variation at a multigene cluster at chromosome 3p21.31 and the ABO blood group have been associated with the risk of developing severe COVID-19, but the mechanism remains unclear. Complement activation has been associated with COVID-19 severity. OBJECTIVE: The aim of this study was to examine whether chromosome 3p21.31 and the ABO variants are linked to the activation of the complement cascade in COVID-19 patients. METHODS: We considered 72 unrelated European hospitalized patients with genetic data and evaluation of circulating C5a and soluble terminal complement complex C5b-9 (SC5b-9). Twenty-six (36.1%) patients carried the rs11385942 G>GA variant and 44 (66.1%) non-O blood group associated with increased risk of severe COVID-19. RESULTS: C5a and SC5-b9 plasma levels were higher in rs11385949 GA carriers than in non-carriers (P = 0.041 and P = 0.012, respectively), while C5a levels were higher in non-O group than in O group patients (P = 0.019). The association between rs11385949 and SC5b-9 remained significant after adjustment for ABO and disease severity (P = 0.004) and further correction for C5a (P = 0.018). There was a direct relationship between upper airways viral load and SC5b-9 in carriers of the rs11385949 risk allele (P = 0.032), which was not observed in non-carriers. CONCLUSIONS: The rs11385949 G>GA variant, tagging the chromosome 3 gene cluster variation and predisposing to severe COVID-19, is associated with enhanced complement activation, both with C5a and terminal complement complex, while non-O blood group with C5a levels. These findings provide a link between genetic susceptibility to more severe COVID-19 and complement activation.

OBJECTIVE. Assess the impact of interventions introduced in Costa Rica during 2020 and 2021 to control the COVID-19 pandemic. METHODS. A Bayesian Poisson regression model was used, incorporating control or intervention measures as independent variables in the changes in reported case numbers per epidemiological week. RESULTS. The results showed the relative and combined impact of containment policies and measures on the reduction of cases: mainly vehicular traffic restrictions, use of masks, and implementation of health guidelines and protocols. Evidence of impact was optimized and made available for decision-making by the countrys health and emergency authorities. Several iterations were generated for constant monitoring of variations in impact at four different moments in the pandemics spread. CONCLUSION. The simultaneous implementation of different mitigation measures in Costa Rica has been a driving force in reducing the number of COVID-19 cases.

Due to Covid-19, fellowship programs could not conduct in-person interviews during the 2020C2021 interview cycle and were forced to implement virtual interviews. We conducted two nationwide surveys of residency and fellowship Program Directors (PDs) involved in the Obstetrics and Gynecology (Ob/Gyn) Subspecialty Fellowship match cycle to gain a better understanding of virtual interviews from each of their perspectives. 1) Fellowship PDs confidence in using a virtual platform to holistically evaluate applicants during the 2020C2021 match cycle, 2) Residency PDs perception of virtual interviews and impact on their programs operations, and 3) to assess the desire of fellowship and residency PDs to continue virtual recruitment during forthcoming interview seasons. Two separate nationwide web-based surveys were administered to 1) Ob/Gyn fellowship PDs and 2) residency PDs through SurveyMonkey from July-September 2020 to assess the impact of virtual interviews form each parties perspective. Surveys solicited demographic information, four-point Likert scale questions, and free response questions Of programs meeting inclusion criteria, 75/111 (67.6%) fellowship PDs and 67/117 (57.3%) residency PDs responded to their respective surveys. Most fellowship PDs believed that they could confidently assess applicants professionalism (88%) during a virtual interview and (90.7%) felt confident in making a rank-order list. However, only 73.3% were just as confident in preparing a rank list after a virtual interview as they have been with in-person interviews. Most residency PDs (69.9%) believed that virtual interviews made it easier for their program to comply with duty hours, and 76.8% agreed that virtual interviews allowed their residents to accept more interviews than an in-person format. Most fellowship PDs found virtual interviews convenient. However, difficulty in observing social interaction and gauging applicant interest may be the biggest challenge moving forward.

Introduction HIV incidence is high during pregnancy and postpartum in many settings. PrEP is safe and effective but requires adherence during potential HIV exposure, yet the facilitators of high maternal adherence are not well understood in high HIV burden settings. Methods We conducted semi structured interviews with women who reported high adherence (PrEP use >25 days in last 30-days) within a PrEP service for pregnant and postpartum women located in a large primary care facility in a high HIV burden township. Topics for interviews included: individual/interpersonal risk, disclosure, anticipated PrEP stigma, safety, side effects, and facility level factors effecting adherence. A thematic approach guided an iterative process of coding (reviewed to ensure intercoder reliability) and analysis using NVivo 12. Results We interviewed 25 postpartum women with high PrEP adherence who were on PrEP for a median of 9-months, median age 26-years, and median baseline gestational age 24-weeks. Themes identified as key drivers of optimal PrEP use were HIV risk perception, primarily due to partners perceived risky sexual behaviors and unknown serosatus, and a strong desire to have a baby free of HIV. Reported disclosure of PrEP use to family, partners and friends facilitated PrEP adherence. Women continued PrEP postpartum because they felt empowered by PrEP and did not want to go backwards and increase their HIV risk as before PrEP. Women who reported high adherence all discussed having community support and reminders to take PrEP on time. The primary barriers were anticipated or experienced stigma, which most overcame through education of partners/family about PrEP. Pregnant women experienced transient side effects, but found ways to continue, including taking PrEP at night. Women believed PrEP education and counselling were accessible when integrated into antenatal care which contributed to continued PrEP use. Conclusions Facilitators of optimal PrEP use through pregnancy and postpartum included fear of HIV acquisition for self and infant, mostly due to partner sexual behaviors and unknown serostatus, along with PrEP disclosure, and encouragement from partners and family. PrEP programs for pregnant and postpartum women should integrate strategies to assist women with realistic appraisals of risk and teach skills for securing support for significant others.

: Since the beginning of 2020, the world has been confronted by the Covid-19 pandemic. The lock-down aims to limit the circulation of the virus and thus avoid overwhelming healthcare systems. Healthcare workers have had to adapt by postponing consultation and surgical activities. Otolaryngologists are particularly exposed to infection from the upper airway where the virus is highly concentrated. Literature has previously reported other human coronaviruses in the middle ear and mastoid, suggesting a risk of infection to staff during ear surgery where aerosolizing procedures are usually used. The aim of this article is to propose a strategy for planning consultations and surgeries for ear and lateral skull base diseases, in the context of the current active evolution of the pandemic and of the future gradual recovery to normal practice.

Objective: To determine the maternal and perinatal impact of pregnant women with SARS-CoV-2 positive polymerase chain reaction during childbirth and post clinical period. Method: Observational descriptive, retrospective, and multicentre study carried out through the review of clinical records of pregnant women admitted for delivery from 1 March to 30 June 2020. Results: Thirteen women with SARS-CoV-2 positive polymerase chain reaction were tested. The prevalence of positive cases was 0.48% of the total number of births attended during the study period. None of the mothers developed complications from COVID-19 infection, nor did they require admission to the Intensive Care Unit. Of the births,15.4% ended in caesarean section, 7.7% were premature, 53.8% of the newborns were isolated from their mothers, 61.5% had late clamping of the umbilical cord and the rate of exclusive breastfeeding at discharge was 76.9%. All the newborns were polymerase chain reaction-negative for COVID-19 and had no postpartum complications. Conclusions: Vertical transmission during childbirth in newborns of COVID-19 positive mothers has not been reported. Clinical practices not supported by scientific evidence were detected at the beginning of the pandemic and adapted to international recommendations as the pandemic evolved.

AIM: To compare the efficacy of different components of online and contact anatomy classes as perceived by medical students. METHODS: An anonymous course evaluation survey was conducted at the end of the academic year 2019/2020. The organization of classes due to the SARS-CoV-2 pandemic provided our students with a unique opportunity to compare online and contact classes. Students' responses were analyzed according to the type of obtained data (ratio, ordinal, and categorical). RESULTS: The response rate was 95.58%. Approximately 90% of students found anatomical dissection and practical work in general to be the most important aspect of teaching, which could not be replaced by online learning. During online classes, students missed the most the interaction with other students, followed by the interaction with student teaching assistants and teaching staff. Very few students found contact lectures useful, with most students reporting that they could be replaced with recorded video lectures. In contrast, recorded video lectures were perceived as extremely helpful for studying. Regular weekly quizzes were essential during online classes as they gave students adequate feedback and guided their learning process. Students greatly benefitted from additional course materials and interactive lessons, which were made easily available via e-learning platform. CONCLUSIONS: Anatomical dissection and interaction during contact classes remain the most important aspects of teaching anatomy. However, online teaching increases learning efficiency by allowing alternative learning strategies and by substituting certain components of contact classes, thus freeing up more time for practical work.

The purpose of this investigation was to assess the effect of compression sleeves on muscle activation cost during locomotion. Twenty-two recreationally active men (age: 25 3 years) ran on a treadmill at four different speeds (ordered sequence of 2.8, 3.3, 2.2, and 3.9 m/s). The tests were performed without (control situation, CON) and while wearing specially designed lower leg compression sleeves (SL). Myoelectric activity of five lower leg muscles (tibialis anterior, fibularis longus, lateral and medial head of gastrocnemius, and soleus) was captured using Surface EMG. To assess muscle activation cost, the cumulative muscle activity per distance travelled (CMAPD) of the CON and SL situations was determined. Repeated measures analyses of variance were performed separately for each muscle. The analyses revealed a reduced lower leg muscle activation cost with respect to test situation for SL for all muscles (p < 0.05, p2 > 0.18). The respective significant reductions of CMAPD values during SL ranged between 4% and 16% and were largest at 2.8 m/s. The findings presented point towards an improved muscle activation cost while wearing lower leg compression sleeves during locomotion that have potential to postpone muscle fatigue.

BACKGROUND Minimally invasive esophagectomy (MIE) is gaining increasing popularity in the treatment of esophageal cancer. In fact, while surgical and oncologic outcomes are not inferior to those achieved through a traditional open approach, patients undergoing MIE benefit from shorter length of stay, lesser pain and prompter recovery. This technique is, however, highly challenging, and the development of a MIE program, even in the setting of a tertiary center, requires time and progressive honing of surgical skills. METHODS We use a minimally invasive Ivor Lewis approach. The abdominal phase of the procedure includes complete celiac lymphadenectomy and tubularization of the stomach, which will constitute the neo-esophagus. The video-assisted thoracoscopic surgery portion of the operation takes place in left lateral decubitus and allows for optimal thoracic lymphadenectomy and anastomosis. RESULTS From October 2011 to January 2015, we treated 52 patients with the above-described procedure. The evolution of our anastomotic technique included a first group of circular stapled anastomosis with Orvil? and 3.5-mm EEA? (n = 16 patients), subsequently abandoned in favor of a linear anastomosis (n = 12), before going back to the Orvil? coupled with 4.8-mm EEA? (n = 22) in more recent times. There were also an additional two anastomoses that did not fall under any of these categories. We experienced two postoperative deaths. The overall leak rate was 14%, but fell down to 4% in the last group. Median LOS was 9 days. Lymph node retrieval was adequate throughout the whole series. CONCLUSIONS Developing a MIE program requires a significant learning curve before the results plateau. Only once a technique of choice is refined and mastered, the advantages granted by MIE become apparent.

Differential activation of CD4+ T cell subsets in vivo leads to the development of qualitatively different effector responses. We identify an approach that allows selective activation of strongly Th1-dominated immune responses to protein antigens. Whereas in vivo administration of ovalbumin (OVA) induces cytokine synthesis that is neither Th1 nor Th2 dominated, administration of glutaraldehyde polymerized, high relative molecular weight OVA (OA-POL) leads to 20-fold increase in the ratio of interferon gamma (IFN-gamma)/IL-4 and IFN-gamma/IL-10 synthesis observed after short-term, antigen-mediated restimulation directly ex vivo. In contrast, concurrent in vivo administration of anti-IFN-gamma mAb and OVA or OA-POL results in marked increases in IL-4 and IL-10, and decreased IFN-gamma production, reflecting a polarization of the response towards a Th2-like pattern of cytokine synthesis. These observations may be useful in clinical settings including hypersensitivity, autoimmune diseases, and vaccine development where the ability to actively select specific patterns of cytokine gene expression would be advantageous.

Poor public health information is a hurdle in infectious disease control. The study aims to examine whether healthcare workers adhere to hand hygiene and mask-wearing guidelines during the COVID-19 pandemic and to explore their exposure to misinformation about the pandemic as a predictor. A cross-sectional survey was sent to 518 healthcare workers across Indonesia, the fourth largest nation in the world, in September 2020 during the COVID-19 pandemic. The respondents reported whether they adhered to the guidelines of hand hygiene and mask wearing and whether they believed in four pieces of misinformation about the origin, severity, contagion, and prevention of COVID-19. The association between misinformation and hand hygiene and mask wearing was tested with logistic regression models controlling for demographic and health-related covariates. Approximately 25% of healthcare workers did not always adhere to hand hygiene guidelines and approximately 5% did not adhere to mask-wearing guidelines. There are significant associations between all four pieces of misinformation and hand hygiene and mask wearing. It is important to improve public health information about COVID-19, which may hold key to healthcare workers hand hygiene and mask wearing and to protect their health and patients safety.

The first COVID-19 confinement induced dramatic changes in the lives of adolescents, but little is known about the processes that affected youth engagement with school during this period. This study addressed this issue by uncovering a stress process model of school engagement during confinement, based on confinement stressors and adolescent resources. Data were collected from 406 French adolescents and their parents (grades 6 through 9, 47% girls). The results showed that multiple stressors (parental anxiety, lack of Internet or computer, low relevant and unclear school activities) and resources (academic self-concept, parental support and teacher support) affected engagement, and that some effects intertwined (e.g., effects of low relevant and unclear school activities were moderated and mediated by academic self-concept). Implications are drawn on ways to tackle stress processes and help adolescents stay engaged with schoolwork during confinement.

Soon after they were first described in 1990, aptamers were largely recognized as a new class of biological ligands that can rival antibodies in various analytical, diagnostic, and therapeutic applications. Aptamers are short single-stranded RNA or DNA oligonucleotides capable of folding into complex 3D structures, enabling them to bind to a large variety of targets ranging from small ions to an entire organism. Their high binding specificity and affinity make them comparable to antibodies, but they are superior regarding a longer shelf life, simple production and chemical modification, in addition to low toxicity and immunogenicity. In the past three decades, aptamers have been used in a plethora of therapeutics and drug delivery systems that involve innovative delivery mechanisms and carrying various types of drug cargos. However, the successful translation of aptamer research from bench to bedside has been challenged by several limitations that slow down the realization of promising aptamer applications as therapeutics at the clinical level. The main limitations include the susceptibility to degradation by nucleases, fast renal clearance, low thermal stability, and the limited functional group diversity. The solution to overcome such limitations lies in the chemistry of aptamers. The current review will focus on the recent arts of aptamer chemistry that have been evolved to refine the pharmacological properties of aptamers. Moreover, this review will analyze the advantages and disadvantages of such chemical modifications and how they impact the pharmacological properties of aptamers. Finally, this review will summarize the conjugation strategies of aptamers to nanocarriers for developing targeted drug delivery systems.

COVID-19 has caused a major global pandemic and necessitated unprecedented public health restrictions in almost every country. Understanding risk factors for severe disease in hospitalised patients is critical as the pandemic progresses. This observational cohort study aimed to characterise the independent associations between the clinical outcomes of hospitalised patients and their demographics, comorbidities, blood tests and bedside observations. All patients admitted to Northwick Park Hospital, London, UK between 12 March and 15 April 2020 with COVID-19 were retrospectively identified. The primary outcome was death. Associations were explored using Cox proportional hazards modelling. The study included 981 patients. The mortality rate was 36.0%. Age (adjusted hazard ratio (aHR) 1.53), respiratory disease (aHR 1.37), immunosuppression (aHR 2.23), respiratory rate (aHR 1.28), hypoxia (aHR 1.36), Glasgow Coma Scale <15 (aHR 1.92), urea (aHR 2.67), alkaline phosphatase (aHR 2.53), C-reactive protein (aHR 1.15), lactate (aHR 2.67), platelet count (aHR 0.77) and infiltrates on chest radiograph (aHR 1.89) were all associated with mortality. These important data will aid clinical risk stratification and provide direction for further research.

We consider the task of discovering categories of non-pharmaceutical interventions during the evolving COVID-19 pandemic. We explore topic modeling on two corpora with national and international scope. These models discover existing categories when compared with human intervention labels while reduced human effort needed.

BACKGROUND: Sepsis is a life-threatening organ dysfunction and a major healthcare burden worldwide. Although sepsis is a medical emergency that requires immediate management, screening for the occurrence of sepsis is difficult. Herein, we propose a deep learning-based model (DLM) for screening sepsis using electrocardiography (ECG). METHODS: This retrospective cohort study included 46,017 patients who were admitted to two hospitals. A total of 1,548 and 639 patients had sepsis and septic shock, respectively. The DLM was developed using 73,727 ECGs from 18,142 patients, and internal validation was conducted using 7774 ECGs from 7,774 patients. Furthermore, we conducted an external validation with 20,101 ECGs from 20,101 patients from another hospital to verify the applicability of the DLM across centers. RESULTS: During the internal and external validations, the area under the receiver operating characteristic curve (AUC) of the DLM using 12-lead ECG was 0.901 (95% confidence interval, 0.882C0.920) and 0.863 (0.846C0.879), respectively, for screening sepsis and 0.906 (95% confidence interval (CI), 0.877C0.936) and 0.899 (95% CI, 0.872C0.925), respectively, for detecting septic shock. The AUC of the DLM for detecting sepsis using 6-lead and single-lead ECGs was 0.845C0.882. A sensitivity map revealed that the QRS complex and T waves were associated with sepsis. Subgroup analysis was conducted using ECGs from 4,609 patients who were admitted with an infectious disease, and the AUC of the DLM for predicting in-hospital mortality was 0.817 (0.793C0.840). There was a significant difference in the prediction score of DLM using ECG according to the presence of infection in the validation dataset (0.277 vs. 0.574, p < 0.001), including severe acute respiratory syndrome coronavirus 2 (0.260 vs. 0.725, p = 0.018). CONCLUSIONS: The DLM delivered reasonable performance for sepsis screening using 12-, 6-, and single-lead ECGs. The results suggest that sepsis can be screened using not only conventional ECG devices but also diverse life-type ECG machines employing the DLM, thereby preventing irreversible disease progression and mortality.

Background: Novel Coronavirus (COVID-19), a highly contagious ssRNA +ve sense virus that emerged in late 2019, has created a global panic. With no effective therapy available, the virus has significantly affected the world population causing millions of death. Therefore, it is the utmost need to look towards all the possible strategies to benefit the community. Objectives: In view of the current global pandemic, we tried to discuss the potential benefits of two cost-effective alternative approaches, i.e., physical exercise and yoga. Methods: The editorial is based on a literature search available on PubMed, Google Scholar, and WHO portal. Search terminologies include "yoga," "physical exercise," "COVID-19," "viral infections," and a combination of these words. Results: A literature search defines yoga and physical exercise efficacy in different viral diseases, including HIV, influenza, and HSV. It ameliorates the Quality of Life (QoL) by improving both the physical and mental well-being of an individual. This is mainly done by promoting the better functioning of the immune system (increases CD4+ and CD8+ cells and reduces pro-inflammatory response). Conclusions: Regular involvement of these activities in day-to-day life may limit latent virus reactivations and reduce infection chances.

Feline coronavirus (FCoV) infection initiates monocyte-associated viremia and viral persistence Virus-infected, -activated monocytes also trigger feline infectious peritonitis (FIP), a fatal systemic disease of felids typified by granulomatous (peri)phlebitis Currently, the exact mechanisms inducing monocyte activation and FIP are unknown This study attempted to identify the potential immediate effect of virulent FCoV on colony-stimulating factor (CSF) (granulocyte (G)-CSF, monocyte (M)-CSF and granulocyte-monocyte (GM)-CSF levels through in vitro assessment, alongside prototypical pro- and anti-inflammatory mediators (interleukin (IL)-1, IL-6, IL-12p40, tumor necrosis factor (TNF)-, and IL-10);this was assessed alongside the in vivo situation in the hemolymphatic tissues of cats euthanized with natural end-stage FIP For the in vitro work, isolated monocytes from SPF cats were cultured short-term and infected with the FIP virus (FIPV) strain DF2 Mediator transcription was assessed by quantitative reverse transcriptase PCR (RT-qPCR) at 3, 6 and 9 h post infection (hpi), and in the post-mortem samples of bone marrow, spleen, and mesenteric lymph nodes (MLN) of cats with FIP We observed limited and transient changes in cytokine transcription in monocytes after infection, i e , a significant increase of IL-6 at 3 hpi and of GM-CSF over the 3 and 6 hpi period, whereas M-CSF was significantly decreased at 9 hpi, with a limited effect of age The findings indicate that the infection induces expansion of the monocyte/macrophage population, which would ensure the sufficient supply of cells for consistent viral replication In natural disease, the only upregulation was of G-CSF in the MLN, suggesting either immune exhaustion or an active downregulation by the host as part of its viral response

A mental health coalition on April 1 in urged the federal government to provide personal protection equipment (PPE) to all behavioral health care professionals on the frontlines of the COVID\19 pandemic. The letter, signed by the National Council for Behavioral Health, the National Alliance on Mental Illness, Mental Health America and the American Psychiatric Association, states that the lack of PPE is putting behavioral health care workers at risk.

Feminist insights have already played an important role in our rapidly developing understanding of COVID-19. Intersectional research has drawn attention to the disproportionate impact of the pandemic on women of color?particularly in the care industry and essential services?as well as the amplified discrimination faced by LGBTQI+ people. Understanding the pandemic as a gendered catastrophe builds outward from feminist anthropological research, thematizing two key areas: (1) masculinity and (2) the home as a site of gendered labor. Since the 1970s anthropologists have led scholarly debates about the domestic?public distinction, and since the 1990s they have incorporated feminist theory into the disciplinary mainstream's engagement with men and manhood. Paying attention to how familiar dichotomies such as nature/culture and public/private operate during the crisis can yield unexpected insights and alliances, offering powerful conceptual tools to turn feminist anthropology's lens on those most disadvantaged by COVID-19. The COVID-19 pandemic has created major compliance challenges for institutions of higher education, including in the area of student privacy. At various times during the pandemic, postsecondary institutions have been panned for their lack of transparency over COVID-19 infection rates on campus.