BACKGROUND: Human bocavirus (HBoV) is a newly identified human parvovirus. HBoV is associated with upper and lower respiratory tract infections and gastroenteritis in children. Little is known about the seroepidemiology of HBoV in populations in the Caribbean. METHODS: In a cross-sectional study conducted at the University Hospital of the West Indies in Kingston, Jamaica, 287 blood samples were collected from pediatric patients and tested for the presence of HBoV-specific antibody using a virus-like-particle based enzyme-linked immunosorbent assay (ELISA). RESULTS: HBoV-specific antibodies were found to be present in 220/287 (76.7%) of samples collected from the pediatric population. Seroprevalence of HBoV was highest in those 2 years old. The seroepidemiological profile suggests that most children are exposed to HBoV during the first two years of life in Jamaica. CONCLUSION: HBoV infection is common in children in Jamaica. HBoV seroprevalence rates in the Caribbean are similar to those previously reported in other areas of the world.

The COVID-19 outbreak and lockdown have been associated with multiple consequences for mental health, including an excessive and potentially harmful increase in screen media use. The specific consequences for children, adolescents and young adults with ADHD are still unknown. In the first part of this study, a short review of problematic use of the internet (PUI) in ADHD is presented, showing that patients with ADHD are at risk for different aspects of PUI, such as excessive gaming or problematic social media use. In the second part, we report original data of an online survey on screen media use before, during and after the lockdown completed by parents of children and adolescents clinically referred for ADHD. Parents rated children's/adolescents' media-related behavior and media time on a new screening questionnaire for PUI. Each item was rated three times, referring to the observed behavior before, during and 1-2 months after the lockdown. N = 126 parents of patients referred for ADHD aged 10-18 years participated in the study. Total media time increased by 46% during the lockdown and did not completely return to pre-Corona levels afterwards. Patients with difficulties concentrating, high irritability or deterioration of ADHD problems under lockdown spent more time with screen media than those with milder or no such problems. While the effects of the lockdown on screen media use and its negative impact on everyday life appear to be largely reversible, a small proportion of patients with ADHD apparently continue to show increased media use.

Smallholder farmers social knowledge systems are evolving in connecting key actors within and outside their knowledge systems. These key actors play a vital role in navigating the complexity and the dynamics of organisations, and effectively influence the community. This study identified the opinion leaders of smallholder farmers and measured the extent of their influence on the quality of these farmers knowledge of agriculture. Furthermore, the study explored the reasons why farmers choose their opinion leaders. A structured questionnaire was administered to 219 purposively selected smallholder farmers in the rural areas in KwaZulu-Natal, South Africa. Data were captured and analysed using the Statistical Package for Social Sciences (SPSS) version 26 and STATA to run multinomial logistic regression model (MNL). The results showed that farmers participated in field visits and attended farmers group meetings to communicate with agricultural advisors and group leaders. In addition, the findings showed that interactions could be a crucial element of knowledge and learning for farmers. This showed that the farmers required a consistent flow of material resources and knowledge. The time and energy spent by farmers building social relationships with these opinion leaders reflected the accumulation of information and resources gathered. Issues related to accessibility, availability and, quick feedback regarding farmers problems emerged, which seemed to influence the farmers choice of an opinion leader. The language and accessibility to sources of knowledge and feedback were crucial to the smallholder farmers included in the study. Furthermore, the results revealed that farmers educational level, farmers who engaged in agriculture for household consumption, and opinion agricultural skills have statistical significance on farmers choice of opinion leaders. Considering the findings, it is suggested that efforts to improve farmers active knowledge systems and access to the opinion leaders within these active knowledge systems should take into consideration the socio-economic factors that influence farmers choices and participation in social systems and social interactions. These findings may help agents develop a better understanding of the dynamics of local communities and the social complexity that shapes farmers environments and decisions. To be a progressive and effective opinion leader, constant, continuous assessment is needed to increase leadership skills. In addition, the enhancement of programmes, which will recognise the active opinion leaders within the communities, are needed to strengthen the efforts and impact for more resilient outcomes.

Ferroptosis is a newly discovered type of regulated cell death that is different from apoptosis, necrosis and autophagy. Ferroptosis is characterized by iron-dependent lipid peroxidation, which induces cell death. Iron, lipid and amino acid metabolism is associated with ferroptosis. Ferroptosis is involved in the pathological development of various diseases, such as neurological diseases and cancer. Recent studies have shown that ferroptosis is also closely related to acute lung injury (ALI)/ acute respiratory distress syndrome (ARDS), suggesting that it can be a novel therapeutic target. This article mainly introduces the metabolic mechanism related to ferroptosis and discusses its role in ALI/ARDS to provide new ideas for the treatment of these diseases.

Bordetella bronchiseptica is a gram-negative coccobacillus that colonizes the respiratory system of mammals such as dogs, cats, rabbits and others and might cause upper respiratory tract infections. Although it can be rarely pathogenic in humans, there are several case reports describing infections in humans. We describe the case of a patient without prolonged immunosuppression or underlying diseases, with bacteremia from Bordetella bronchiseptica, while being treated in a tertiary hospital for COVID-19 infection.

INTRODUCTION Historically the presence of liver cirrhosis has been an absolute or relative contraindication to laparoscopic cholecystectomy (LC). Accumulating experience in LC has resulted in an increasing number of investigators reporting that LC can be safely performed in cirrhotic patients. The aim of this study was to report the efficacy and safety of LC in the treatment of symptomatic cholelithiasis in cirrhotic patients, and a review of the literature in the matter. METHODS Between January 2006 and July 2010, from 503 patients under LC, we reviewed 43 cirrhotic patients of Child-Pugh Classification A, B, and C, with symptomatic gallstones. RESULTS Conversion to an open procedure was necessary in 5 patients due to multiple factors. The mean operative time and length of hospital stay were significantly longer and higher in cirrhotic group (P<0.05). Postoperative complications were observed in 37.2% of patients. Trocar site hematoma (P=0.02), wound complications (P=0.02), and intra-abdominal collection (P=0.01) occurred more frequently in patients with cirrhosis (Child B and C class) than in patients without cirrhosis. One case of continuing hemorrhage from the gallbladder bed required a reoperation for hemostasis. Two patients with Child-Pugh class C and 1 patient with class B cirrhosis developed ascites after surgery; 1 patient with Child-Pugh class A had bile leakage. No deaths occurred. CONCLUSIONS LC is an effective and safe procedure and should be the treatment of choice for symptomatic cholelithiasis or cholecystitis in patients with compensated cirrhosis.

Thickness-dependent magnetic behavior has previously been observed in chemical vapor deposition-grown chromium selenide. However, the low-dimensional structure in nonlayered chromium selenide, which plays a crucial role in determining the low-dimensional magnetic order, needs further study. Here, we report the structure-dependent magnetic properties in monolayer CrSe2 and Cr2Se3 grown by molecular beam epitaxy. In the monolayer CrSe2, 1T-CrSe2 with a lattice constant of 3.3 ? has a metallic character, coexisting with the 1T phase with 2 2 surface periodicity. Monolayer CrSe2 can be transformed into Cr2Se3 with a lattice constant of 3.6 ? by annealing at 300 C. X-ray magnetic circular dichroism (XMCD) measurements combined with DFT calculations reveal that while the MBE-grown monolayer CrSe2 is antiferromagnetic, monolayer Cr2Se3 is ferromagnetic with a Curie temperature of 200 K. This work demonstrates the structural diversity in nonlayered chromium selenide and the critical effect of different structures on its electronic and magnetic properties.

Prevention strategies for COVID-19 transmission are at the forefront of healthcare paradigms worldwide, the main emphasis of which is vaccination. We present an interesting case of a 37-year-old man who, 3 weeks following his first dose of the chimpanzee adenovirus-vectored COVID-19 vaccine, ChAdOx1, presented to hospital with a rapidly progressive ascending muscle weakness and back pain in the absence of any other triggers. He also had a negative COVID-19 swab during admission. A diagnosis of Guillain-Barre syndrome was confirmed by correlating the clinical features with cerebrospinal fluid analysis, nerve conduction studies and MRI of the brain and whole spine. The patient received treatment with 5 days of intravenous immunoglobulin and did not require any respiratory support. He was also regularly reviewed by a multidisciplinary team consisting of neurologists, speech and language therapists, and physiotherapists and is on the course to a recovery.

PurposeThe purpose of this paper is to investigate COVID-19 as a super crisis in the design and management of places.Design/methodology/approachThis theory-driven work outlines why and how, by treating COVID-19 as a super crisis, the immunological view rises in priority and swiftly ushers in short- and long-term implications for space design and place management.FindingsFirst, this paper looks at the short-term impact of COVID-19 upon space and place management in addressing how porous bubbling, stippling and flexible curtaining respond to immediate retrofitting needs during the pandemic. Using the concept of COVID-19-induced collective trauma, this paper draws attention to health-care facilities, schools, workplaces, commercial buildings and public outdoor spaces. These sites require short-term improvisation in place and space design and will, where the collective trauma of COVID-19 leaves strong traces, require long-term redesign and rethinking.Social implicationsAs a super crisis, COVID-19 generates contradictions in the existing trend in space and place studies from the notion of space and place as a container to one focusing on flow. A focus on flow highlights a focus on space and place as adaptable to changes in flow, especially as augmented and mediated by technology.Originality/valueThis treatment of COVID-19 as a super crisis is intended to stimulate the design and management of spaces and places in the post-COVID-19 period.

OBJECTIVE The purpose of the study was to report the outcomes of our modified techniques of laparoscopic urachal resection, followed by novel umbilical-plasty using dermal regenerative grafts for symptomatic urachal remnants. METHODS Between March 2014 and December 2016, laparoscopic urachal resection was carried out on 45 patients with complaints of urachal remnants. After extraction of the specimen and closure of the fascia at the umbilical site, a 1-cm square section of dermal regeneration sheet (TERUDERMIS?, Olympus) was suture retained between the fascia and the skin. Patient satisfaction with cosmesis was scored prospectively using the visual analogue scale (VAS). Perioperative records were reviewed to assess surgical outcomes. RESULTS Laparoscopic urachal resection was successfully conducted via the transperitoneal approach. Postoperative bleeding was experienced in one patient (2.2%), which was subsequently controlled laparoscopically. Infection subsided with symptomatic relief in all patients. No symptomatic recurrences were encountered. Over 80% of patients (37/45) rated the cosmetic outcome of the plasty as good to excellent, with the median scores of 8 (range 5-10). CONCLUSIONS Laparoscopic urachal resection is safe and curative with reasonable risk of complications. Novel umbilicoplasty using dermal regenerative graft is very simple technique and offers satisfactory cosmetic outcomes. Further follow-up and cosmesis evaluation are required.

The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semi-urgent (to be attended to within 30-90 days), example highly symptomatic chronic venous disease, and (4) discretionary/non-urgent- (to be seen within 6-12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.

Analytical observations (in silico) indicate molecular features of SARS-Cov2 genome that potentially explains the high prevalence of asymptomatic cases in Covid-19 pandemic. We observed that the virus maintains a low preference for GGG codon for glycine (3%) in its genome. We also observed multiple putative introns of 26C44 nucleotide (nt) length in the genomic region between the coding regions of Nsp10 and RPol in the viral ORF1ab, like several other beta-coronaviruses of similar infectivity levels. It appears that the virus employs a dual strategy to ensure unhindered replication within the host. One of the strategies employ a (? )1 frameshift translation event through programmed ribosomal slippage at the ribosomal slippage site in the ORF1ab. The alternate strategy relies on intron excision to generate a read through frame. The presence of GGG in this conserved ribosomal slippage site ensures adequate tRNA in cytoplasm to match the codon, implying no additional frameshift translation due to ribosomal stalling. With fewer replication events, viral load remains low and resulting in asymptomatic cases. We suggest that this strategy is the primary reason for the prevalence of asymptomatic cases in the disease, enabling the virus to spread rapidly. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12064-021-00349-3.

Following the rising crisis of COVID-19 and the Oregon governor's stay-at-home orders, members of the Oregon Health and Science University (OHSU) inpatient addiction consult service recognized that local addiction treatment and recovery organizations were operating at limited capacity. As a result, discharge planning, patient access to local community-based treatment, and safety-net programming were affected. Given structural and intersectional risk vulnerabilities of people with substance use disorders (SUDs), the OHSU members felt that COVID-19 would disproportionately impact chronically marginalized members of our community. These inequities inspired the formation of the Oregon substance use disorder resources collaborative (ORSUD) led by four medical students. ORSUD's mission is to support the efforts of local safety-net organizations that and front-line providers who serve chronically marginalized community members in the midst of the global pandemic. We operationalized our mission through: 1) collecting and disseminating operational and capacity changes in local addiction and harm reduction services to the broader treatment community, and 2) identifying and addressing immediate resource needs for local safety-net programs. Our program uses a real-time public-facing document to collate local programmatic updates and general community resources. COVID-19 disproportionately burdens people with SUDs; thus, ORSUD exists to support programs serving people with SUDs and will continue to evolve to meet their needs and the needs of those who serve them.

South Africa, similar to many other countries in the African continent is still experiencing challenges in its efforts to provide sexual and reproductive health (SRH) care to women and adolescent girls, and it has become clear that the COVID-19 pandemic is the latest threat to universal access to SRH. In the face of this threat, the Sustainable Developmental Goals that call on the global community to -leave no one behind may become a blurred vision unless we adopt a wider lens away from the tunnel vision that currently plagues health systems around the globe. This paper therefore exposes how SRH may become collateral damage in the face of the present COVID-19 pandemic. Previous disease outbreaks diverted attention from critical SRH services, including antenatal care, safe abortions, contraception, HIV/AIDS and sexually transmitted infections. Governments, policy makers, health system gatekeepers and civil society organisations should not allow the COVID-19 phobia to bar women and adolescent girls from accessing SRH services. In fact, the global and South African response to the COVID-19 pandemic must protect everyone's rights, particularly in the health care context. Gender considerations and a human rights approach must be embedded in ensuring the accessibility and availability of SRH services.

Chikungunya virus (CHIKV) is a mosquito-borne alphavirus that causes epidemic fever, rash and polyarthralgia in Africa and Asia. Although it is known since the 1950s, new epidemiological and clinical features reported during the recent outbreak in the Indian Ocean can be regarded as the emergence of a new disease. Numerous severe forms of the infection have been described that put emphasis on the lack of efficient antiviral therapy. Among the virus-encoded enzymes, nsP2 constitutes an attractive target for the development of antiviral drugs. It is a multifunctional protein of approximately 90 kDa with a helicase motif in the N-terminal portion of the protein while the papain-like protease activity resides in the C-terminal portion. The nsP2 proteinase is an essential enzyme whose proteolytic activity is critical for virus replication. In this work, a recombinant CHIKV nsP2pro and a C-terminally truncated variant were expressed in Escherichia coli and purified by metalCchelate chromatography. The enzymatic properties of the proteinase were then determined using specific synthetic fluorogenic substrates. This study constitutes the first characterization of a recombinant CHIKV nsP2 cysteine protease, which may be useful for future drug screening.

These authors reflect on how covid-19 has impacted on patient participation in policy and decision making in the Netherlands

Als we een pati?nt in de stoel laten zitten en vervolgens achterover leggen om in de mond te kijken, krijgen we vaak een goed overzicht van de schedel, oren en het gezicht. Vooral bij wat oudere mannen met een hoog voorhoofd of kalende schedel zie je wat roodverkleurde, ruw aanvoelende korstige plekjes. De plekjes zitten nogal eens op plaatsen die veel aan zonlicht zijn blootgesteld: het aangezicht, voorhoofd, onbehaarde schedel, oren, hals en decollet. Maar ook wel op onderarmen en onderbenen. Deze plekken zijn Actinische Keratosen (AK).

Transmission chains within cities provide an important contribution to case burden and economic impact during the ongoing COVID-19 pandemic, and should be a major focus for preventive measures to achieve containment. Here, at very high spatio-temporal resolution, we analysed determinants of SARS-CoV-2 transmission in a medium-sized European city. We combined detailed epidemiological, mobility, and socioeconomic data-sets with whole genome sequencing during the first SARS-CoV-2 wave. Both phylogenetic clustering and compartmental modelling analysis were performed based on the dominating viral variant (B.1-C15324T; 60% of all cases). Here we show that transmissions on the city population level are driven by the socioeconomically weaker and highly mobile groups. Simulated vaccination scenarios showed that vaccination of a third of the population at 90% efficacy prioritising the latter groups would induce a stronger preventive effect compared to vaccinating exclusively senior population groups first. Our analysis accounts for both social interaction and mobility on the basis of molecularly related cases, thereby providing high confidence estimates of the underlying epidemic dynamics that may readily be translatable to other municipal areas.

CONTEXT: During the Ebola outbreak in West Africa in 2014-2015, close cooperation between the curative sector and the public health sector in the Netherlands was necessary for timely identification, referral, and investigation of patients with suspected Ebola virus disease (EVD). OBJECTIVE: In this study, we evaluated experiences in preparedness among stakeholders of both curative and public health sectors to formulate recommendations for optimizing preparedness protocols. Timeliness of referred patients with suspected EVD was used as indicator for preparedness. DESIGN: In focus group sessions and semistructured interviews, experiences of curative and public health stakeholders about the regional and national process of preparedness and response were listed. Timeliness recordings of all referred patients with suspected EVD (13) were collected from first date of illness until arrival in the referral academic hospital. RESULTS: Ebola preparedness was considered extensive compared with the risk of an actual patient, however necessary. Regional coordination varied between regions. More standardization of regional preparation and operational guidelines was requested, as well as nationally standardized contingency criteria, and the National Centre for Infectious Disease Control was expected to coordinate the development of these guidelines. For the timeliness of referred patients with suspected EVD, the median delay between first date of illness until triage was 2.0 days (range: 0-10 days), and between triage and arrival in the referral hospital, it was 5.0 hours (range: 2-7.5 hours). In none of these patients Ebola infection was confirmed. CONCLUSIONS: Coordination between the public health sector and the curative sector needs improvement to reduce delay in patient management in emerging infectious diseases. Standardization of preparedness and response practices, through guidelines for institutional preparedness and blueprints for regional and national coordination, is necessary, as preparedness for emerging infectious diseases needs a multidisciplinary approach overarching both the public health sector and the curative sector. In the Netherlands a national platform for preparedness is established, in which both the curative sector and public health sector participate, in order to implement the outcomes of this study.

Severe acute respiratory-syndrome coronavirus-2 (SARS-CoV-2) host cell infection is mediated by binding to angiotensin-converting enzyme 2 (ACE2). Systemic dysregulation observed in SARS-CoV was previously postulated to be due to ACE2/angiotensin 1-7 (Ang1-7)/Mas axis downregulation; increased ACE2 activity was shown to mediate disease protection. Because angiotensin II receptor blockers, ACE inhibitors, and mineralocorticoid receptor antagonists increase ACE2 receptor expression, it has been tacitly believed that the use of these agents may facilitate viral disease; thus, they should not be used in high-risk patients with cardiovascular disease. Based on the anti-inflammatory benefits of the upregulation of the ACE2/Ang1-7/Mas axis and previously demonstrated benefits of lung function improvement in SARS-CoV infections, it has been hypothesized that the benefits of treatment with renin-angiotensin system inhibitors in SARS-CoV-2 may outweigh the risks and at the very least should not be withheld.