Evaluation Study on the Use of Non-Contact Prevention and Protection Products in the Context of COVID-19: A Comprehensive Evaluation Method from AHP and Entropy Weight Method.

In the post-epidemic era, there is an endless supply of epidemic prevention products that cover a wide range of public areas. The introduction of such products has eased the tense pattern of virus proliferation in the context of the epidemic, and effectively demonstrated the initiatives implemented by the Chinese people in response to the outbreak. This paper therefore begins with the study of contactless epidemic prevention products, which appear in a form that meets the needs of contemporary society and offers a new mode of living to it. It enriches the measures for epidemic prevention and control. By obtaining satisfaction ratings from the user community, the performance of such products can be understood in time to provide a substantial basis for the subsequent upgrading and optimization or transformation of such products. This study uses the KJ method and questionnaires to construct an index system for contactless epidemic prevention products, grasp users' needs for epidemic prevention products in real time, classify and identify such products, and select such products as epidemic prevention smart security gates, medical delivery robots, infrared handheld thermometers, thermographic body temperature screening, contactless inductive lift buttons, and contactless medical vending machines. The questionnaire was designed with four dimensions: safety, intelligence, aesthetics and economy. A sample size of 262 was collected through the distribution of questionnaires. We used AHP and entropy weighting methods for the comprehensive evaluation; AHP basically tells us how satisfied most users are with this type of product. The use of the entropy weighting method can achieve objectivity in the weighting process. Combining the two approaches helps to improve the scientific nature of the weighting of the evaluation indexes for contactless and epidemic-proof products. It is clear from the AHP analysis that, firstly, there are differences in the perceptions of the performance of this type of product between different age groups. Secondly, the user group rated the perceived performance of the product presented as high (Bn>0.200), which users can subjectively and directly perceive. Next, the perceived future sustainable economic development of this product category is low (Bn≤0.200), and users place low importance on its economic aspects as an objective additional condition. The entropy method of analysis shows that, under reasonable government control of the market for intelligent products, the safety, intelligence and aesthetic effects of these products are significant (Cm≤0.100); further, the economic presentation of these products has yet to be optimized and upgraded (Cm>0.100).

Rapid synthesis of bismuth-organic frameworks as selective antimicrobial materials against microbial biofilms.

Antibiotic resistance is a global public health threat, and urgent actions should be undertaken for developing alternative antimicrobial strategies and approaches. Notably, bismuth drugs exhibit potent antimicrobial effects on various pathogens and promising efficacy in tackling SARS-CoV-2 and related infections. As such, bismuth-based materials could precisely combat pathogenic bacteria and effectively treat the resultant infections and inflammatory diseases through a controlled release of Bi ions for targeted drug delivery. Currently, it is a great challenge to rapidly and massively manufacture bismuth-based particles, and yet there are no reports on effectively constructing such porous antimicrobial-loaded particles. Herein, we have developed two rapid approaches (i.e., ultrasound-assisted and agitation-free methods) to synthesizing bismuth-based materials with ellipsoid- (Ellipsoids) and rod-like (Rods) morphologies respectively, and fully characterized physicochemical properties. Rods with a porous structure were confirmed as bismuth metal-organic frameworks (Bi-MOF) and aligned with the crystalline structure of CAU-17. Importantly, the formation of Rods was a 'two-step' crystallization process of growing almond-flake-like units followed by stacking into the rod-like structure. The size of Bi-MOF was precisely controlled from micro-to nano-scales by varying concentrations of metal ions and their ratio to the ligand. Moreover, both Ellipsoids and Rods showed excellent biocompatibility with human gingival fibroblasts and potent antimicrobial effects on the Gram-negative oral pathogens including Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Fusobacterium nucleatum. Both Ellipsoids and Rods at 50 â€‹µg/mL could disrupt the bacterial membranes, and particularly eliminate P. gingivalis biofilms. This study demonstrates highly efficient and facile approaches to synthesizing bismuth-based particles. Our work could enrich the administration modalities of metallic drugs for promising antibiotic-free healthcare.

A global view of hypertensive disorders and diabetes mellitus during pregnancy.

Two important maternal cardiometabolic disorders (CMDs), hypertensive disorders in pregnancy (HDP) (including pre-eclampsia) and gestational diabetes mellitus (GDM), result in a large disease burden for pregnant individuals worldwide. A global consensus has not been reached about the diagnostic criteria for HDP and GDM, making it challenging to assess differences in their disease burden between countries and areas. However, both diseases show an unevenly distributed disease burden for regions with a low income or middle income, or low-income and middle-income countries (LMICs), or regions with lower sociodemographic and human development indexes. In addition to many common clinical, demographic and behavioural risk factors, the development and clinical consequences of maternal CMDs are substantially influenced by the social determinants of health, such as systemic marginalization. Although progress has been occurring in the early screening and management of HDP and GDM, the accuracy and long-term effects of such screening and management programmes are still under investigation. In addition to pharmacological therapies and lifestyle modifications at the individual level, a multilevel approach in conjunction with multisector partnership should be adopted to tackle the public health issues and health inequity resulting from maternal CMDs. The current COVID-19 pandemic has disrupted health service delivery, with women with maternal CMDs being particularly vulnerable to this public health crisis.

Correlation between SARS-CoV-2 RNA concentration in wastewater and COVID-19 cases in community: A systematic review and meta-analysis.

Wastewater-based epidemiology (WBE) has been considered as a promising approach for population-wide surveillance of coronavirus disease 2019 (COVID-19). Many studies have successfully quantified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentration in wastewater (CRNA). However, the correlation between the CRNA and the COVID-19 clinically confirmed cases in the corresponding wastewater catchments varies and the impacts of environmental and other factors remain unclear. A systematic review and meta-analysis were conducted to identify the correlation between CRNA and various types of clinically confirmed case numbers, including prevalence and incidence rates. The impacts of environmental factors, WBE sampling design, and epidemiological conditions on the correlation were assessed for the same datasets. The systematic review identified 133 correlation coefficients, ranging from -0.38 to 0.99. The correlation between CRNA and new cases (either daily new, weekly new, or future cases) was stronger than that of active cases and cumulative cases. These correlation coefficients were potentially affected by environmental and epidemiological conditions and WBE sampling design. Larger variations of air temperature and clinical testing coverage, and the increase of catchment size showed strong negative impacts on the correlation between CRNA and COVID-19 case numbers. Interestingly, the sampling technique had negligible impact although increasing the sampling frequency improved the correlation. These findings highlight the importance of viral shedding dynamics, in-sewer decay, WBE sampling design and clinical testing on the accurate back-estimation of COVID-19 case numbers through the WBE approach.

Vertical outbreak of COVID-19 in high-rise buildings: The role of sewer stacks and prevention measures.

COVID-19 outbreaks in high-rise buildings suggested the transmission route of fecal-aerosol-inhalation due to the involvement of viral aerosols in sewer stacks. The vertical transmission is likely due to the failure of water traps that allow viral aerosols to spread through sewer stacks. This process can be further facilitated by the chimney effect in vent stack, extract ventilation in bathrooms, or wind-induced air pressure fluctuations. To eliminate the risk of such vertical disease spread, the installation of protective devices is highly encouraged in high-rise buildings. Although the mechanism of vertical pathogen spread through drainage pipeline has been illustrated by tracer gas or microbial experiments and numerical modeling, more research is needed to support the update of regulatory and design standards for sewerage facilities.

Analyzing the influence of COVID-19 epidemic on the employment intention of resident physicians in China.

INTRODUCTION: To investigate the effects and influencing factors of the COVID-19 epidemic on the employment intention of resident physicians in China. METHODOLOGY: 409 questionnaires were statistically analyzed after removing the missing values. We used the Chi-Square test for single-factor analysis and logistic regression analysis for multivariate analysis. The questions include the residents' employment intention and their willingness to engage in epidemic-related subspecialties and participate in epidemic-related work. RESULTS: Residents of severe and high-risk epidemic regions had much lower employment intentions than those of stable epidemic regions (OR = 1.917, 95% CI: 1.024, 3.591, p = 0.042). The higher the Center for Epidemiologic Studies Depression Scale (CES-D) score, the more susceptible was the resident's employement intention (OR = 1.085, 95% CI: 1.044, 1.128, p < 0.001). Residents from severe and high-risk epidemic regions were more willing to participate in clinical work (OR = 4.263, 95% CI: 1.892, 9.604, p < 0.001), and the higher the CES-D score, the lower was the proportion of residents willing to choose clinical work (OR = 0.941, 95% CI: 0.893, 0.992, p = 0.023). Residents from severe epidemics and high-risk provinces were less willing to participate in respiratory medicine (χ2 = 5.070, p = 0.027) and critical care medicine (χ2 = 7.046, p = 0.011). Compared to residents with bachelor's degrees, residents with master's and doctoral degrees were less willing to participate in isolation wards (OR = 1.831, 95% CI: 1.122, 2.990, p = 0.016). Residents in epidemic-related current rotation departments were less willing to go to Wuhan as volunteers (OR = 2.197, 95% CI: 1.110, 4.347, p = 0.024). CONCLUSIONS: The COVID-19 outbreak had a negative impact on the job intentions of Chinese residents in general.

Epidemiology, Clinical Features, and Outcomes of Multisystem Inflammatory Syndrome in Children (MIS-C) and Adolescents-a Live Systematic Review and Meta-analysis.

Purpose of Review: A multisystem inflammatory condition occurring in children and adolescents with COVID-19 has become increasingly recognized and widely studied globally. This review aims to investigate and synthesize evolving evidence on its clinical characteristics, management, and outcomes in pediatric patients. Recent Findings: We retrieved data from PubMed, EMBASE, Cochrane Library, WHO COVID-19 Database, Google Scholar, and preprint databases, covering a timeline from December 1, 2019, to July 31, 2021. A total of 123 eligible studies were included in the final descriptive and risk factor analyses. We comprehensively reviewed reported multisystem inflammatory syndrome in children (MIS-C) cases from published and preprint studies of various designs to provide an updated evidence on epidemiology, clinical, laboratory and imaging findings, management, and short-term outcomes. Latest evidence suggests that African black and non-Hispanic white are the two most common ethnic groups, constituting 24.89% (95% CI 23.30-26.48%) and 25.18% (95% CI 23.51-26.85%) of the MIS-C population, respectively. Typical symptoms of MIS-C include fever (90.85%, 95% CI 89.86-91.84%), not-specified gastrointestinal symptoms (51.98%, 95% CI 50.13-53.83%), rash (49.63%, 95% CI 47.80-51.47%), abdominal pain (48.97%, 95% CI 47.09-50.85%), conjunctivitis (46.93%, 95% CI 45.17-48.69%), vomiting (43.79%, 95% CI 41.90-45.68%), respiratory symptoms (41.75%, 95% CI 40.01-43.49%), and diarrhea (40.10%, 95% CI 38.23-41.97%). MIS-C patients are less likely to develop conjunctivitis (OR 0.27, 95% CI 0.11-0.67), cervical adenopathy (OR 0.21, 95% CI 0.07-0.68), and rash (OR 0.44, 95% CI 0.26-0.77), in comparison with Kawasaki disease patients. Our review revealed that the majority of MIS-C cases (95.21%) to be full recovered while only 2.41% died from this syndrome. We found significant disparity between low- and middle-income countries and high-income countries in terms of clinical outcomes. Summary: MIS-C, which appears to be linked to COVID-19, may cause severe inflammation in organs and tissues. Although there is emerging new evidence about the characteristics of this syndrome, its risk factors, and clinical prognosis, much remains unknown about the causality, the optimal prevention and treatment interventions, and long-term outcomes of the MIS-C patients. Supplementary Information: The online version contains supplementary material available at 10.1007/s40124-022-00264-1.

SARS-CoV-2 shedding sources in wastewater and implications for wastewater-based epidemiology.

Wastewater-based epidemiology (WBE) approach for COVID-19 surveillance is largely based on the assumption of SARS-CoV-2 RNA shedding into sewers by infected individuals. Recent studies found that SARS-CoV-2 RNA concentration in wastewater (CRNA) could not be accounted by the fecal shedding alone. This study aimed to determine potential major shedding sources based on literature data of CRNA, along with the COVID-19 prevalence in the catchment area through a systematic literature review. Theoretical CRNA under a certain prevalence was estimated using Monte Carlo simulations, with eight scenarios accommodating feces alone, and both feces and sputum as shedding sources. With feces alone, none of the WBE data was in the confidence interval of theoretical CRNA estimated with the mean feces shedding magnitude and probability, and 63% of CRNA in WBE reports were higher than the maximum theoretical concentration. With both sputum and feces, 91% of the WBE data were below the simulated maximum CRNA in wastewater. The inclusion of sputum as a major shedding source led to more comparable theoretical CRNA to the literature WBE data. Sputum discharging behavior of patients also resulted in great fluctuations of CRNA under a certain prevalence. Thus, sputum is a potential critical shedding source for COVID-19 WBE surveillance.

Artificial neural network-based estimation of COVID-19 case numbers and effective reproduction rate using wastewater-based epidemiology.

As a cost-effective and objective population-wide surveillance tool, wastewater-based epidemiology (WBE) has been widely implemented worldwide to monitor the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentration in wastewater. However, viral concentrations or loads in wastewater often correlate poorly with clinical case numbers. To date, there is no reliable method to back-estimate the coronavirus disease 2019 (COVID-19) case numbers from SARS-CoV-2 concentrations in wastewater. This greatly limits WBE in achieving its full potential in monitoring the unfolding pandemic. The exponentially growing SARS-CoV-2 WBE dataset, on the other hand, offers an opportunity to develop data-driven models for the estimation of COVID-19 case numbers (both incidence and prevalence) and transmission dynamics (effective reproduction rate). This study developed artificial neural network (ANN) models by innovatively expanding a conventional WBE dataset to include catchment, weather, clinical testing coverage and vaccination rate. The ANN models were trained and evaluated with a comprehensive state-wide wastewater monitoring dataset from Utah, USA during May 2020 to December 2021. In diverse sewer catchments, ANN models were found to accurately estimate the COVID-19 prevalence and incidence rates, with excellent precision for prevalence rates. Also, an ANN model was developed to estimate the effective reproduction number from both wastewater data and other pertinent factors affecting viral transmission and pandemic dynamics. The established ANN model was successfully validated for its transferability to other states or countries using the WBE dataset from Wisconsin, USA.

Successful application of wastewater-based epidemiology in prediction and monitoring of the second wave of COVID-19 with fragmented sewerage systems-a case study of Jaipur (India).

The present study tracked the city-wide dynamics of severe acute respiratory syndrome-corona virus 2 ribonucleic acids (SARS-CoV-2 RNA) in the wastewater from nine different wastewater treatment plants (WWTPs) in Jaipur during the second wave of COVID-19 out-break in India. A total of 164 samples were collected weekly between February 19th and June 8th, 2021. SARS-CoV-2 was detected in 47.2% (52/110) influent samples and 37% (20/54) effluent samples. The increasing percentage of positive influent samples correlated with the city's increasing active clinical cases during the second wave of COVID-19 in Jaipur. Furthermore, wastewater-based epidemiology (WBE) evidence clearly showed early detection of about 20 days (9/9 samples reported positive on April 20th, 2021) before the maximum cases and maximum deaths reported in the city on May 8th, 2021. The present study further observed the presence of SARS-CoV-2 RNA in treated effluents at the time window of maximum active cases in the city even after tertiary disinfection treatments of ultraviolet (UV) and chlorine (Cl2) disinfection. The average genome concentration in the effluents and removal efficacy of six commonly used treatments, activated sludge process + chlorine disinfection (ASP + Cl2), moving bed biofilm reactor (MBBR) with ultraviolet radiations disinfection (MBBR + UV), MBBR + chlorine (Cl2), sequencing batch reactor (SBR), and SBR + Cl2, were compared with removal efficacy of SBR + Cl2 (81.2%) > MBBR + UV (68.8%) > SBR (57.1%) > ASP (50%) > MBBR + Cl2 (36.4%). The study observed the trends and prevalence of four genes (E, RdRp, N, and ORF1ab gene) based on two different kits and found that prevalence of N > ORF1ab > RdRp > E gene suggested that the effective genome concentration should be calculated based on the presence/absence of multiple genes. Hence, it is imperative to say that using a combination of different detection genes (E, N, RdRp, & ORF1ab genes) increases the sensitivity in WBE.

Rapid screening and identification of viral pathogens in metagenomic data.

BACKGROUND: Virus screening and viral genome reconstruction are urgent and crucial for the rapid identification of viral pathogens, i.e., tracing the source and understanding the pathogenesis when a viral outbreak occurs. Next-generation sequencing (NGS) provides an efficient and unbiased way to identify viral pathogens in host-associated and environmental samples without prior knowledge. Despite the availability of software, data analysis still requires human operations. A mature pipeline is urgently needed when thousands of viral pathogen and viral genome reconstruction samples need to be rapidly identified. RESULTS: In this paper, we present a rapid and accurate workflow to screen metagenomics sequencing data for viral pathogens and other compositions, as well as enable a reference-based assembler to reconstruct viral genomes. Moreover, we tested our workflow on several metagenomics datasets, including a SARS-CoV-2 patient sample with NGS data, pangolins tissues with NGS data, Middle East Respiratory Syndrome (MERS)-infected cells with NGS data, etc. Our workflow demonstrated high accuracy and efficiency when identifying target viruses from large scale NGS metagenomics data. Our workflow was flexible when working with a broad range of NGS datasets from small (kb) to large (100 Gb). This took from a few minutes to a few hours to complete each task. At the same time, our workflow automatically generates reports that incorporate visualized feedback (e.g., metagenomics data quality statistics, host and viral sequence compositions, details about each of the identified viral pathogens and their coverages, and reassembled viral pathogen sequences based on their closest references). CONCLUSIONS: Overall, our system enabled the rapid screening and identification of viral pathogens from metagenomics data, providing an important piece to support viral pathogen research during a pandemic. The visualized report contains information from raw sequence quality to a reconstructed viral sequence, which allows non-professional people to screen their samples for viruses by themselves (Additional file 1).

Molecular dynamic simulation analysis of SARS-CoV-2 spike mutations and evaluation of ACE2 from pets and wild animals for infection risk.

Coronavirus Disease 2019 (COVID-19) is an ongoing global health emergency that has caused tremendous stress and loss of life worldwide. The viral spike glycoprotein is a critical molecule mediating transmission of SARS-CoV-2 by interacting with human ACE2. However, through the course of the pandemics, there has not been a thorough analysis of the spike protein mutations, and on how these mutants influence the transmission of SARS-CoV-2. Besides, cases of SARS-CoV-2 infection among pets and wild animals have been reported, so the susceptibility of these animals requires great attention to investigate, as they may also link to the renewed question of a possible intermediate host for SARS-CoV-2 before it was transmitted to humans. With over 226,000 SARS-CoV-2 sequences obtained, we found 1573 missense mutations in the spike gene, and 226 of them were within the receptor-binding domain (RBD) region that directly interacts with human ACE2. Modeling the interactions between SARS-CoV-2 spike mutants and ACE2 molecules showed that most of the 74 missense mutations in the RBD region of the interaction interface had little impact on spike binding to ACE2, whereas several within the spike RBD increased the binding affinity toward human ACE2 thus making the virus likely more contagious. On the other hand, modeling the interactions between animal ACE2 molecules and SARS-CoV-2 spike revealed that many pets and wild animals' ACE2 had a variable binding ability. Particularly, ACE2 of bamboo rat had stronger binding to SARS-CoV-2 spike protein, whereas that of mole, vole, Mus pahari, palm civet, and pangolin had a weaker binding compared to human ACE2. Our results provide structural insights into the impact on interactions of the SARS-CoV-2 spike mutants to human ACE2, and shed light on SARS-CoV-2 transmission in pets and wild animals, and possible clues to the intermediate host(s) for SARS-CoV-2.

Enhanced decay of coronaviruses in sewers with domestic wastewater.

Recent outbreaks caused by coronaviruses and their supposed potential fecal-oral transmission highlight the need for understanding the survival of infectious coronavirus in domestic sewers. To date, the survivability and decay of coronaviruses were predominately studied using small volumes of wastewater (normally 5-30 mL) in vials (in-vial tests). However, real sewers are more complicated than bulk wastewater (wastewater matrix only), in particular the presence of sewer biofilms and different operational conditions. This study investigated the decay of infectious human coronavirus 229E (HCoV-229E) and feline infectious peritonitis virus (FIPV), two typical surrogate coronaviruses, in laboratory-scale reactors mimicking the gravity (GS, gravity-driven sewers) and rising main sewers (RM, pressurized sewers) with and without sewer biofilms. The in-sewer decay of both coronaviruses was greatly enhanced in comparison to those reported in bulk wastewater through in-vial tests. 99% of HCoV-229E and FIPV decayed within 2 h under either GS or RM conditions with biofilms, in contrast to 6-10 h without biofilms. There is limited difference in the decay of HCoV and FIPV in reactors operated as RM or GS, with the T90 and T99 difference of 7-10 min and 14-20 min, respectively. The decay of both coronaviruses in sewer biofilm reactors can be simulated by biphasic first-order kinetic models, with the first-order rate constant 2-4 times higher during the first phase than the second phase. The decay of infectious HCoV and FIPV was significantly faster in the reactors with sewer biofilms than in the reactors without biofilms, suggesting an enhanced decay of these surrogate viruses due to the presence of biofilms and related processes. The mechanism of biofilms in virus adsorption and potential inactivation remains unclear and requires future investigations. The results indicate that the survivability of infectious coronaviruses detected using bulk wastewater overestimated the infectivity risk of coronavirus during wastewater transportations in sewers or the downstream treatment.

The combined regimens of antiviral therapy might not be useful for the viral clearance of severe COVID-19 cases.

BACKGROUND: Severe COVID-19 caused by SARS-CoV-2 should closely be cared because of the relatively high mortality rate. If SARS-CoV-2 could be cleared as soon as possible, the mortality rate might lower. In the present study, we analyzed factors which might be related to the clearance of SARS-CoV-2. METHODS: One hundred and twenty-eight severe COVID-19 cases were enrolled. All of them had been isolated and treated at Shenzhen Third People's Hospital because they were positive for nucleic acid of SARS-CoV-2 tested by qRT-PCR. Their baseline clinical characteristics and antiviral regimens were collected and analyzed, respectively. RESULTS: Of the 128 enrolled severe COVID-19 cases, unfortunately 3 died. The mean viral duration of all patients was 23.5 (range 17-32) days. All patients achieved viral clearance during 9 weeks. 13.4% of patients achieved viral clearance within 2 weeks, and 63.0% of patients achieved viral clearance within 4 weeks. The combined regimens of three or more antiviral drugs, the use of invasive mechanical ventilation, and late admission might be related to the delay of viral clearance within 2 weeks. The use of arbidol, the use of invasive mechanical ventilation, and late admission might be related to the delay of viral clearance within 4 weeks. Patients often had a prolonged course of COVID-19 and hospitalization, and were more likely transferred to intensive care unit (ICU) for treatment, if they could not clear SARS-CoV-2 during 23 days. CONCLUSION: Severe COVID-19 cases should be admitted to hospital as soon as possible. The combined regimens of three or more antiviral drugs might not be useful for viral clearance, and should be performed carefully and cautiously.

Analytical performance comparison of four SARS-CoV-2 RT-qPCR primer-probe sets for wastewater samples.

Current studies have confirmed the feasibility of SARS-CoV-2 RNA detection by RT-qPCR assays in wastewater samples as an effective surveillance tool of COVID-19 prevalence in a community. Analytical performance of various RT-qPCR assays has been compared against wastewater samples based on the positive ratio. However, there is no systematic comparison work has been conducted for both analytical sensitivity and quantitative reliability against wastewater, which are essential factors for WBE. In this study, the detection performance of four RT-qPCR primer-probe sets, including CCDC-N, CDC-N1, N-Sarbeco, and E-Sarbeco, was systematically evaluated with pure synthetized plasmids, spiked wastewater mocks and raw wastewater samples. In addition to confirm RT-qPCR results, Nanopore sequencing was employed to delineate at molecular level for the analytical sensitivity and reproducibility of those primer-probe sets. CCDC-N showed high sensitivity and the broadest linearity range for wastewater samples. It was thus recommended to be the most efficient tool in the quantitative analysis of SARS-CoV-2 in wastewater. CDC-N1 had the highest sensitivity for real wastewater and thus would be suitable for the screening of wastewater for the presence of SARS-CoV-2. When applying the primer-probe sets to wastewater samples collected from different Australian catchments, increased active clinical cases were observed with the augment of SARS-CoV-2 RNA quantified by RT-qPCR in wastewater in low prevalence communities.

Pseudo-Anaphylactic Reactions to Pfizer BNT162b2 Vaccine: Report of 3 Cases of Anaphylaxis Post Pfizer BNT162b2 Vaccination.

Anaphylactic reactions were observed after Singapore's national coronavirus disease 2019 (COVID-19) vaccination programme started in December 2020. We report the clinical and laboratory features of three patients in our institution who developed anaphylactic reactions after receiving the Pifzer BNT162b2 vaccine. IgM and IgG antibodies, but not IgE antibodies to the Pfizer BNT162b2 vaccine, were detected in all subjects. Similarly, mild to high elevated levels of anti-polyethylene glycol (PEG) IgG (1035-19709 U/mL, vs. vaccine-naive < 265 U/mL, vaccine-tolerant < 785 U/mL) and IgM (1682-5310 U/mL, vs. vaccine-naive < 1011 U/mL, vaccine-tolerant < 1007 U/mL) were detected in two out of three patients via commercial ELISA. High levels of serum anaphylatoxin C3a (79.0 ± 6.3 µg/mL, mean ± SD, vs. normal < 10 µg/mL) were observed in all three patients during the acute phase of the reaction, while tryptase levels, a marker of mast cell activation, were not elevated. Finally, one patient with the highest levels of anti-PEG IgG, IgM, and anti-Pfizer BNT162b2 IgG and IgM exhibited an enhanced Th2 cytokine serum profile during an acute reaction, with high levels of IL-4 (45.7 pg/mL, vs. vaccine-naive/tolerant < 2.30 pg/mL), IL-33 (86.4 pg/mL, vs. vaccine-naive/tolerant < 5.51 pg/mL) and IL-10 (22.9 pg/mL, vs. vaccine-naive/tolerant < 12.49 pg/mL) diminishing over time following corticosteroid treatment. Taken together, we propose these cases of anaphylaxis described are driven by a complement activation-related pseudoallergy (CAPRA), rather than classical IgE-mediated mechanisms.

Leveraging health information technology to collect family cancer history: a systematic review and meta-analysis

Collection of an accurate and comprehensive family cancer history (FCH) can help to identify millions of individuals at risk-for familial cancer syndromes. However, there are no formal guidelines for FCH collection and, as a result, there is wide variability in in strategies employed and accuracy of family health history across medical systems. Information technology (IT) provides a promising solution, a tool that has been shown to improve clinical documentation, workflows, quality of care, patient safety, communication and clinical decision support, and that can be completed remotely and safely during a pandemic. The aim of this study is to evaluate the literature on existing strategies whereby medical providers utilize information technology (IT) to assemble FCH. A systematic search of online databases (PubMed, EMBASE, MEDLINE, and the Cochrane Library) between 1980 and 2020 was performed. Meta-analysis was used to estimate pooled results across studies. Statistical heterogeneity was assessed through the chi-square test (i.e., Cochrane Q test) and the inconsistency statistic (I2). A random effects analysis was used to calculate the pooled proportions and means. The comprehensive search produced 4005 publications. Thirty-two peer-reviewed studies met inclusion criteria. Twenty-seven distinct IT tools were evaluated which included the following categories: electronic survey administered prior to visit (21, 65.6%), electronic survey administered via tablet in the medical office (6, 18.8%), electronic survey via kiosk (4, 12.5%) and animated virtual counselor (1, 3.1%). Among the 196,566 included patients, 87.0% completed the FCH tool (electronic survey prior to the visit - 85.0 %;electronic survey in the medical office - 89.0 %). The time required for survey completion was 35.2 minutes (CI 14.3 -56.2). Twelve percent of patients (n=11,093) were referred for genetic assessment based on the output of the FCH tool. Among the studied methods of FCH collection, 7 (21.9%) had the capacity to interface directly with the patient's electronic medical record. [Display omitted] The rapidly advancing field of germline cancer genetics coupled with a growing emphasis on disease prevention and incorporation of technology into medical care algorithms prior to and accelerated by the COVID-19 pandemic make utilization of IT strategies for collection of FCH a promising option. Our systematic review and meta-analysis found that electronic FCH collection can be completed successfully by patients in a time efficient manner. This information may be useful as many healthcare systems continue to restructure the way in which patients interact with their healthcare teams. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Probiotics use is associated with improved clinical outcomes among hospitalized patients with COVID-19.

BACKGROUND AND AIMS: Currently, there are no definitive therapies for coronavirus disease 2019 (COVID-19). Gut microbial dysbiosis has been proved to be associated with COVID-19 severity and probiotics is an adjunctive therapy for COIVD-19. However, the potential benefit of probiotics in COVID-19 has not been studied. We aimed to assess the relationship of probiotics use with clinical outcomes in patients with COVID-19. METHODS: We conducted a propensity-score matched retrospective cohort study of adult patients with COVID-19. Eligible patients received either probiotics plus standard care (probiotics group) or standard care alone (non-probiotics group). The primary outcome was the clinical improvement rate, which was compared among propensity-score matched groups and in the unmatched cohort. Secondary outcomes included the duration of viral shedding, fever, and hospital stay. RESULTS: Among the propensity-score matched groups, probiotics use was related to clinical improvement rates (log-rank p = 0.028). This relationship was driven primarily by a shorter (days) time to clinical improvement [difference, -3 (-4 to -1), p = 0.022], reduction in duration of fever [-1.0 (-2.0 to 0.0), p = 0.025], viral shedding [-3 (-6 to -1), p < 0.001], and hospital stay [-3 (-5 to -1), p = 0.009]. Using the Cox model with time-varying exposure, use of probiotics remained independently related to better clinical improvement rate in the unmatched cohort. CONCLUSION: Our study suggested that probiotics use was related to improved clinical outcomes in patients with COVID-19. Further studies are required to validate the effect of probiotics in combating the COVID-19 pandemic.

SARS-CoV-2 and other pathogens in municipal wastewater, landfill leachate, and solid waste: A review about virus surveillance, infectivity, and inactivation.

This review discusses the techniques available for detecting and inactivating of pathogens in municipal wastewater, landfill leachate, and solid waste. In view of the current COVID-19 pandemic, SARS-CoV-2 is being given special attention, with a thorough examination of all possible transmission pathways linked to the selected waste matrices. Despite the lack of works focused on landfill leachate, a systematic review method, based on cluster analysis, allows to analyze the available papers devoted to sewage sludge and wastewater, allowing to focalize the work on technologies able to detect and treat pathogens. In this work, great attention is also devoted to infectivity and transmission mechanisms of SARS-CoV-2. Moreover, the literature analysis shows that sewage sludge and landfill leachate seem to have a remote chance to act as a virus transmission route (pollution-to-human transmission) due to improper collection and treatment of municipal wastewater and solid waste. However due to the incertitude about virus infectivity, these possibilities cannot be excluded and need further investigation. As a conclusion, this paper shows that additional research is required not only on the coronavirus-specific disinfection, but also the regular surveillance or monitoring of viral loads in sewage sludge, wastewater, and landfill leachate. The disinfection strategies need to be optimized in terms of dosage and potential adverse impacts like antimicrobial resistance, among many other factors. Finally, the presence of SARS-CoV-2 and other pathogenic microorganisms in sewage sludge, wastewater, and landfill leachate can hamper the possibility to ensure safe water and public health in economically marginalized countries and hinder the realization of the United Nations' sustainable development goals (SDGs).