Whenever countries are threatened by a pandemic, as is the case with the COVID-19 virus, governments should take the right actions to safeguard public health as well as to mitigate the negative effects on the economy. In this regard, there are two completely different approaches governments can take: a restrictive one, in which drastic measures such as self-isolation can seriously damage the economy, and a more liberal one, where more relaxed restrictions may put at risk a high percentage of the population. The optimal approach could be somewhere in between, and, in order to make the right decisions, it is necessary to accurately estimate the future effects of taking one or other measures. In this paper, we use the SEIR epidemiological model (Susceptible - Exposed - Infected - Recovered) for infectious diseases to represent the evolution of the virus COVID-19 over time in the population. To optimize the best sequences of actions governments can take, we propose a methodology with two approaches, one based on Deep Q-Learning and another one based on Genetic Algorithms. The sequences of actions (confinement, self-isolation, two-meter distance or not taking restrictions) are evaluated according to a reward system focused on meeting two objectives: firstly, getting few people infected so that hospitals are not overwhelmed with critical patients, and secondly, avoiding taking drastic measures for too long which can potentially cause serious damage to the economy. The conducted experiments prove that our methodology is a valid tool to discover actions governments can take to reduce the negative effects of a pandemic in both senses. We also prove that the approach based on Deep Q-Learning overcomes the one based on Genetic Algorithms for optimizing the sequences of actions.

Aim Introducing possible diagnostic and therapeutic biomarker candidates via the identification of chief dysregulated proteins in COVID-19 patients is the aim of this study. Background Molecular studies, especially proteomics, can be considered as suitable approaches for discovering the hidden aspect of the disease. Methods Differentially expressed proteins (DEPs) of three patients with demonstrated severe condition (S-COVID-19) were compared to healthy cases by a proteomics study. Cytoscape software and STRING database were used to construct the protein-protein interaction (PPI) network. The central DEPs were identified through topological analysis of the network. ClueGO+CluePedia were applied to find the biological processes related to the central nodes. MCODE molecular complex detection (MCODE) was used to discover protein complexes. Results A total of 242 DEPs from among 256 query ones were included in the network. Centrality analysis of the network assigned 16 hub-bottlenecks, nine of which were presented in the highest-scored protein complex. Ten protein complexes were determined. APOA1 was identified as the protein complex seed, and APP, EGF, and C3 were the top hub-bottlenecks of the network. The results specify that up-regulation of C3 and down-regulation of APOA1 in urine play a role in the stiffness in respiration and, accordingly, the severity of COVID-19. Moreover, dysregulation of APP and APOA1 could both contribute to the possible adverse effects of COVID-19 on the nervous system. Conclusion The introduced central proteins of the S-COVID-19 interaction network, particularly APOA1, can be considered as diagnostic and therapeutic targets related to the coronavirus disease after being approved with complementary studies.

Large gastric lipomas are a rare condition. They are often asymptomatic but may present with upper gastrointestinal bleeding or gastric outlet obstruction. We describe the case of a 52-year-old woman with a large gastric lipoma presenting with pain due to intermittent prolapse through the pylorus. The patient was treated using a novel approach of laparoscopic transgastric resection and was discharged on postoperative day 3. She suffered no complication and her histology confirmed a gastric lipoma with clear surgical margins.

Aspergillus species are capable of causing both invasive disease and chronic infections in immunocompromised patients or those with preexisting lung conditions. Aspergillus fumigatus is the most commonly cultured species, and there is increasing concern regarding resistance to the azoles, which are the mainstays of antifungal therapy against aspergillosis. We evaluated the species distribution and susceptibility profiles of isolates within Aspergillus section Fumigati in the United States over a 52-month period. Species identification was performed by combined phenotypic characteristics and DNA sequence analysis, and antifungal susceptibility testing was performed by CLSI M38 broth microdilution for amphotericin B, the azoles, and the echinocandins. The entire CYP51A gene and its promoter were also sequenced in isolates that were phenotypically resistant to the azoles. During the study time frame, 2,138 isolates were included, representing 11 different species within Aspergillus section Fumigati, of which A. fumigatus was the most prevalent (96.91%). Overall, amphotericin B and the echinocandins demonstrated consistent in vitro activity with very few isolates demonstrating reduced susceptibility to these agents. Voriconazole, isavuconazole, and posaconazole also demonstrated good in vitro activity, and the overall percentages of isolates classified as resistant or non-wild type ranged from 3.33 to 6.58%. Mutations within the CYP51A gene leading to amino acid changes associated with azole resistance were found in 75.3% of isolates that were phenotypically resistant or non-wild type and included both those associated with chronic clinical exposure and environmental exposure to the azoles. Further studies are warranted to continue to monitor for azole-resistant A. fumigatus within the United States.

The COVID-19 pandemic had a devastating impact on non-sheltered homeless and housing-insecure individuals. This report details the development of a Chicago-based isolation shelter designed for people experiencing homelessness and recovering from COVID-19. The model is informative concerning the rapid development of services for people marginalized by the health care system.

Following the first report in May 2015 of the unexpected emergence of Zika in north east Brazil, there has been an explosive epidemic of this infection across Latin America. The outbreak has caused alarm among social and news media as to the virulence and transmission potential of the Aedes mosquito-borne virus. This debate is heightened by the proximity, both in time and distance, to the forthcoming Olympic Games to be held in Rio de Janeiro this August, provoking fears for the safety of athletes and spectators alike. The threat, real or perceived, is exacerbated by the movement between nations in the same or separate continents of persons who act unwittingly as asymptomatic carriers. Pregnant females are considered at greatest risk because microcephaly in newborn infants is linked to, if not yet proven as caused by, Zika infection. In February this year, the World Health Organization declared that further to the then unconfirmed association between the virus and the clinical manifestations of microcephaly and also Guillain-Barr syndrome, the Zika epidemic was a public health emergency of international concern. No anti-Zika therapy, vaccine or drug, is currently available and while the production of the former has now been prioritized by multiple funding agencies, the history of infectious disease vaccine development indicates that this may take several years to reach the market place. The fact that Zika is a close relative of yellow fever and Japanese encephalitis viruses, for both of which there are already effective vaccines, provides a rational basis for the fast-tracked laboratory-based preparation of a candidate vaccine. However, undertaking clinical trials on pregnant females provides ethical and practical hurdles to overcome before licensure is granted for public administration. Meanwhile, public health management strategies, including mosquito control programs to reduce breeding, are needed to limit the global spread of this re-emerging disease.

(1) Background: Co-occurrence of mental and substance use disorders (SUD) is prevalent, but complicates their clinical courses, and specific biomarkers are required. Amino acids are altered in primary mental disorders; however, little is known about SUD and psychiatric comorbidity. Because most psychiatric disorders and biomarkers show sex differences, we investigated amino acids in men and women with alcohol and/or cocaine use disorders (AUD and/or CUD) and psychiatric comorbidity. (2) Methods: A cross-sectional study was conducted in 295 participants, who were divided into four groups (AUD, n = 60; CUD, n = 41; AUD + CUD, n = 64; and control, n = 130). Participants were clinically assessed, and plasma amino acid concentrations were analyzed in relation to sex, diagnosis of SUD and psychiatric comorbidity (3) Results: In the total sample, there were sex differences, and women showed lower Iso, Leu, Gln and Glu than men. While patients with CUD and AUD + CUD had higher Glu, Gly, Orn and Ser than controls, patients with AUD showed no differences. In SUD, patients with psychiatric comorbidity had lower Orn and higher Ala than non-comorbid patients in the AUD group. (4) Conclusions: There was a dysregulation of plasma amino acids in abstinent patients with SUD. However, our results suggest the importance of considering the clinical characteristics and sex in the validity of amino acids as potential biomarkers for SUD.

On May 7, 2009, a national network was organized in the Peoples Republic of China for the surveillance, reporting, diagnosis, and treatment of influenza A pandemic (H1N1) 2009 virus infection (pandemic [H1N1] 2009). Persons with suspected cases are required to report to the Chinese Center for Disease Control and Prevention and the Ministry of Health within 24 hours; the patients close contacts are then traced and placed in quarantine for 7 days. We report 3 confirmed early cases of pandemic (H1N1) 2009. Two cases were imported from United States; the other was imported from Canada. The patients exhibited fever and signs and other symptoms that were indistinguishable from those of seasonal influenza. Serial virologic monitoring of pharyngeal swabs showed that they were negative for pandemic (H1N1) 2009 virus by real-time reverse transcriptionCPCR 4C6 days after onset of illness. One close contact whose sample tested positive for pandemic (H1N1) 2009 virus had no symptoms during quarantine. A national network is essential for controlling pandemic (H1N1) 2009.

OBJECTIVE: To investigate knowledge and practice of Brazilian public primary and secondary health care dentists during the coronavirus disease (COVID-19) pandemic. METHODS: An online questionnaire with sociodemographic and COVID-19 knowledge questions was used. RESULTS: A total of 4048 dentists working in the Brazilian public primary and secondary health care system were investigated; 4024 (99.41%) believe that COVID-19 can be transmitted through dental procedures. A fair level of COVID-19 symptoms knowledge by these dentists was observed (3.761.27 of 6.00), as well as the skepticism in personal protective equipment (3382; 83.55%) and biosafety procedures (3278; 80.98%) used as an efficient form of COVID-19 transmission prevention. Country region, performance of social distancing, dental specialty, the use of personal protective equipment, and biosafety preventive measures influenced the likelihood of dentists to perform dental treatment, either elective or urgent, during the COVID-19 pandemic. CONCLUSION: The need of extra preventive barriers for dental treatment may bring an extra financial stress in the Brazilian public primary and secondary health care system, as well as in the patient-dentist relationship, which may have to be reframed. Internationally accepted public guideline policies regarding dental treatment safety, as well as the technological development of preventive tools, are needed to deal with the challenges brought by COVID-19.

INTRODUCTION The early diagnosis of dengue fever and its differentiation from other causes of acute febrile illness is essential for a better outcome. The new generation automated hematology analyzers provide parameters like high fluorescence lymphocyte count (HFLC) and leukocyte cell population data (CPD) representing various leukocytes. We tried to analyze the utility of these parameters in the rapid screening of dengue fever. METHODS The HFLC and the leukocytic CPD from the Sysmex XN1000 analyzer were obtained for 299 cases presenting with acute febrile illness, which included 97 dengue-positive and 202 cases dengue-negative controls. Additionally, 100 healthy controls were also included. The Receiver operative curves (ROC) were drawn to obtain a cut-off value for these parameters for discriminating among the dengue-positive and dengue-negative subgroups and healthy controls. RESULTS The dengue-positive cases showed a significantly increased HFLC among the different groups of controls. The median (range) HFLC% was 1.9(0.30-6.55), 0.20(0.10-0.70), and 0.10(0.0-0.30) in the cases that were positive for dengue, negative for dengue, and healthy controls, respectively. The ROC analysis revealed HFLC% at a cut-off value of 1.75 which can discriminate between dengue-positive and dengue-negative patients, with 52% sensitivity, 90% specificity, 72% positive predictive value (PPV), and 80% negative predictive value (NPV). The regression analysis revealed LY-X, LY-Z, Ly-WX, LY-WZ, and MO-X as independent predictors for dengue fever. CONCLUSION The HFLC and CPD obtained from Sysmex XN1000 hematology analyzer are valuable tools in rapidly screening dengue infection from other febrile illnesses in routine practice.

Respiratory diseases remain a significant cause of global morbidity and mortality and primary care plays a central role in their prevention, diagnosis and management. An e-Delphi process was employed to identify and prioritise the current respiratory research needs of primary care health professionals worldwide. One hundred and twelve community-based physicians, nurses and other healthcare professionals from 27 high-, middle- and low-income countries suggested 608 initial research questions, reduced after evidence review by 27 academic experts to 176 questions covering diagnosis, management, monitoring, self-management and prognosis of asthma, COPD and other respiratory conditions (including infections, lung cancer, tobacco control, sleep apnoea). Forty-nine questions reached 80% consensus for importance. Cross-cutting themes identified were: a need for more effective training of primary care clinicians; evidence and guidelines specifically relevant to primary care, adaption for local and low-resource settings; empowerment of patients to improve self-management; and the role of the multidisciplinary healthcare team.

BACKGROUND: Hepatic ischemia and reperfusion (I/R) injury is commonly associated with surgical liver resection or transplantation, and represents a major cause of liver damage and graft failure. Currently, there are no effective therapies to prevent hepatic I/R injury other than ischemic preconditioning and some preventative strategies. Previously, we have revealed the anti-inflammatory activity of a sweat gland-derived peptide, dermcidin (DCD), in macrophage/monocyte cultures. Here, we sought to explore its therapeutic potential and protective mechanisms in a murine model of hepatic I/R. METHODS: Male C57BL/6 mice were subjected to hepatic ischemia by clamping the hepatic artery and portal vein for 60 min, which was then removed to initiate reperfusion. At the beginning of reperfusion, 0.2 ml saline control or solution of DCD (0.5 mg/kg BW) or DCD-C34S analog (0.25 or 0.5 mg/kg BW) containing a Cys (C)Ser (S) substitution at residue 34 was injected via the internal jugular vein. For survival experiments, mice were subjected to additional resection to remove non-ischemic liver lobes, and animal survival was monitored for 10 days. For mechanistic studies, blood and tissue samples were collected at 24 h after the onset of reperfusion, and subjected to measurements of various markers of inflammation and tissue injury by real-time RT-PCR, immunoassays, and histological analysis. RESULTS: Recombinant DCD or DCD-C34S analog conferred a significant protection against lethal hepatic I/R when given intravenously at the beginning of reperfusion. This protection was associated with a significant reduction in hepatic injury, neutrophilic CXC chemokine (Mip-2) expression, neutrophil infiltration, and associated inflammation. Furthermore, the administration of DCD also resulted in a significant attenuation of remote lung inflammatory injury. Mechanistically, DCD interacted with epidermal growth factor receptor (EGFR), a key regulator of liver inflammation, and significantly inhibited hepatic I/R-induced phosphorylation of EGFR as well as a downstream signaling molecule, protein kinase B (AKT). The suppression of EGFR expression by transducing Egfr-specific shRNA plasmid into macrophages abrogated the DCD-mediated inhibition of nitric oxide (NO) production induced by a damage-associated molecular pattern (DAMP), cold-inducible RNA-binding protein, CIRP. CONCLUSIONS: The present study suggests that human DCD and its analog may be developed as novel therapeutics to attenuate hepatic I/R-induced inflammatory injury possibly by impairing EGFR signaling.

Background: Several reports have determined that cardiovascular diseases (CVDs) are common complications in patients with coronavirus disease 2019 (COVID-19) and lead them to poor outcomes. CVD biomarkers have, thus, great potential to be used as prognostic biomarkers. We aimed to determine the accuracy of CVD biomarkers for the prognosis of the COVID-19 patients outcome via a diagnostic test accuracy (DTA) meta-analysis. Methods: Until September 30, 2020, we searched Web of Sciences, Scopus, and MEDLINE/PubMed databases to obtain related papers. The summary points and lines were calculated using bivariate/HSROC model. As outcomes, we considered critical conditions and mortality. Results: A total of 17 659 patients from 33 studies were included. Five biomarkers, namely increased levels of lactate dehydrogenase (LDH), cardiac troponin I (cTnI), creatine kinase (CK), D-dimer, and thrombocytopenia, met the inclusion criteria. Our results indicated that LDH and cTnI had good accuracy for the prognosis of critical condition (AUC(HSROC)=0.83 and 0.80, respectively), while LDH, cTnI, and D-dimer had acceptable accuracy (AUC(HSROC)=0.74, 0.71, and 0.72, respectively) for the prognosis of mortality. LDH and D-dimer had high sensitivity, whereas cTnI had high specificity. The other biomarkers did not have acceptable accuracy. Significant publication bias was found for D-dimer (P=0.053). Conclusion: Among CVD biomarkers, LDH and cTnI had good accuracy for the prognosis of critical outcomes and acceptable accuracy for the prognosis of mortality, without publication bias. Given their different sensitivities and specificities, we recommend the use of these 2 biomarkers concomitantly.

The novel coronavirus disease 2019 (Covid-19) pandemic has affected millions of patients in almost all countries with over one million cases recorded in Africa where it is a major health challenge. Covid-19 is known to have significant implications for those with pre-existing cardiovascular disease (CVD) and their cardiologists. Patients with pre-existing CVD are at increased risk of morbidity and mortality from Covid-19 due to associated direct and indirect life threatening cardiovascular (CV) complications. Mitigating the risk of such Covid-19 deaths in resource poor communities requires the institution of preventive measures at the primary, secondary and tertiary levels of preventive phenomenon with emphasis at the first two levels. General preventive measures, screening and monitoring of CVD patients for complications and modification of drug treatment and other treatment methods will need to be implemented. Health policy makers and manager should provide required training and retraining of CV health care workers managing Covid-19 patients with CVD, provision of health education, personal protective equipment (PPE), and diagnostic kits.

Bioinformatics is basically the study of informatic processes in biotic systems. Actually what constitutes bioinformatics is not entirely clear and arguably varies depending on who tries to define it. This chapter discusses the considerable progress in infectious diseases research that has been made in recent years using various omics case studies. Bioinformatics is tasked with making sense of it, mining it, storing it, disseminating it, and ensuring valid biological conclusions can be drawn from it. This chapter discusses the current state of play of bioinformatics related to genomics and transcriptomics, briefs metagenomics that finds use in infectious disease research as well as the random sequencing of genomes from a variety of organisms. This chapter explains the various possibilities of pan-genome, transcriptional reshaping and also enormous progress of proteomics study. Bioinformatic algorithms and tools are crucial tools in analyzing the data. The chapter also attempts to provide some details on the various problems and solution in bioinformatics that current-day scientists face while concentrating on second-generation sequencing strategies.

Meningitis, neuropathy, HIV, dengue-since the 1960s, Cuba has faced its share of epidemics. More recently, Cuban health pro-fessionals tackled domestic outbreaks of H1N1 (2009) and Zika (2016), and worked alongside colleagues from around the world to stem Ebola in West Africa; all three were categorized by WHO as public health emergencies of international concern. In December 2019, China reported its fi rst cluster of pneumo-nia cases, later identifi ed as the novel coronavirus disease COVID-19. In January 2020, Cuban authorities convened a multi-sector working group coordinated by the Ministry of Pub-lic Health (MINSAP) and Civil Defense to tailor its national epi-demic control plan to confront the rapidly-spreading disease. The plan features a national reporting system and database, with standard protocols including early case detection, contact tracing and regularly-scheduled public health messaging. In late January, no fewer than six ministries, plus the National Sports and Recreation Institute, Customs, Immigration and national media outlets, came together to adapt domestic proto-cols and design multi-phase control and response mechanisms to combat the SARS-CoV-2 virus.

Mathematical education in general, and mathematics education at high schools in particular, creates favorable conditions for students to develop essential and core competencies and assists students in improving their mathematical competence as a foundation for good learning. It also promotes necessary skills for society, in which mathematical communication skills are essential skills. The purpose of the research is to enhance students' mathematical communication skills while studying ellipse topics. In this study, 87 students in the tenth grade were tested to see if the teaching process for accelerating the development of mathematical communication skills related to ellipse topics was effective and possible. Students in the experimental class were instructed using a four-step learning model with the activities regarding the ACODESA method and mind map, whereas students in the control class were guided using the conventional way of instruction. A study design involving a pre-test, a treatment, and a post-test was used to determine the effectiveness of this type of teaching approach. Quantitative and qualitative analyses of the gathered data assessed the students' progress in mathematical language activities. The findings indicated that most students' mathematical communication skills regarding ellipse topics had improved significantly. The learners towards the above process also showed a positive attitude. In addition, the research findings have important implications and recommendations.

Respiratory symptoms can be caused by different underlying conditions, and are often caused by viral infections, such as Influenza-like illnesses or other emerging viruses like the Coronavirus. These respiratory viruses, often, have common symptoms: coughing, high temperature, congested nose, and difficulty breathing. However, early diagnosis of the type of the virus, can be crucial, especially in cases, such as the COVID-19 pandemic. Among the factors that contributed to the spread of the COVID-19 pandemic were the late diagnosis or misinterpretation of COVID-19 symptoms as regular flu-like symptoms. Research has shown that one of the possible differentiators of the underlying causes of different respiratory diseases could be the cough sound, which comes in different types and forms. A reliable lab-free tool for early and accurate diagnosis, which can differentiate between different respiratory diseases is therefore very much needed, particularly during the current pandemic. This concept paper discusses a medical hypothesis of an end-to-end portable system that can record data from patients with symptoms, including coughs (voluntary or involuntary) and translate them into health data for diagnosis, and with the aid of machine learning, classify them into different respiratory illnesses, including COVID-19. With the ongoing efforts to stop the spread of the COVID-19 disease everywhere today, and against similar diseases in the future, our proposed low cost and user-friendly theoretical solution could play an important part in the early diagnosis.

This research proposes analyzing the influence of new ways of working (NWW) on healthcare professional’s well-being and how these may affect work performance and public service motivation These variables and relationships were important before COVID-19 pandemic, and everything points to the fact that during and after the pandemic their importance will be higher To buffer the potential negative effects of implementing the NWW, both organizations and employees must identify personal (psychological capital) and job resources (inter-role conflict, psychological empowerment, meaning of work) capable of acting as effective moderators to promote employee well-being and avoid negative experiences at work This paper aims to shed light on new ways of coping and adapting to uncertain job requirements such as those that have arisen during COVID-19 Moreover, it highlights the great changes that public healthcare needs to face to improve the quality of the service offered to society It is urgent that public administrators and human resources managers design effective strategies and make effective decisions in which employee well-being and service quality are main priorities

BACKGROUND: SARS-CoV-2 has been detected in stool samples of COVID-19 patients, with potential implications for faecal-oral transmission. Compared to nasopharyngeal swab samples, the complexity of the stool matrix poses a challenge in the detection of the virus that has not yet been solved. However, robust and reliable methods are needed to estimate the prevalence and persistence of SARS-CoV-2 in the gut and to ensure the safety of microbiome-based procedures such as faecal microbiota transplant (FMT). The aim of this study was to establish a sensitive and reliable method for detecting SARS-CoV-2 in stool samples. RESULTS: Stool samples from individuals free of SARS-CoV-2 were homogenised in saline buffer and spiked with a known titre of inactivated virus ranging from 50 to 750 viral particles per 100 mg stool. Viral particles were concentrated by ultrafiltration, RNA was extracted, and SARS-CoV-2 was detected via real-time reverse-transcription polymerase chain reaction (RT-qPCR) using the CDC primers and probes. The RNA extraction procedure we used allowed for the detection of SARS-CoV-2 via RT-qPCR in most of the stool samples tested. We could detect as few as 50 viral particles per 100 mg of stool. However, high variability was observed across samples at low viral titres. The primer set targeting the N1 region provided more reliable and precise results and for this primer set our method had a limit of detection of 1 viral particle per mg of stool. CONCLUSIONS: Here we describe a sensitive method for detecting SARS-CoV-2 in stool samples. This method can be used to establish the persistence of SARS-CoV-2 in stool and ensure the safety of clinical practices such as FMT. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12866-021-02297-w.