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1.
JAMA Intern Med ; 181(2): 294, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1608834

Subject(s)
COVID-19 , Masks , Humans , SARS-CoV-2
2.
J Am Chem Soc ; 143(22): 8333-8343, 2021 06 09.
Article in English | MEDLINE | ID: covidwho-1246323

ABSTRACT

The 5' untranslated region (UTR) of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome is a conserved, functional and structured genomic region consisting of several RNA stem-loop elements. While the secondary structure of such elements has been determined experimentally, their three-dimensional structures are not known yet. Here, we predict structure and dynamics of five RNA stem loops in the 5'-UTR of SARS-CoV-2 by extensive atomistic molecular dynamics simulations, more than 0.5 ms of aggregate simulation time, in combination with enhanced sampling techniques. We compare simulations with available experimental data, describe the resulting conformational ensembles, and identify the presence of specific structural rearrangements in apical and internal loops that may be functionally relevant. Our atomic-detailed structural predictions reveal a rich dynamics in these RNA molecules, could help the experimental characterization of these systems, and provide putative three-dimensional models for structure-based drug design studies.


Subject(s)
COVID-19/virology , RNA, Viral/chemistry , SARS-CoV-2/genetics , 5' Untranslated Regions , Base Sequence , Genome, Viral , Humans , Molecular Dynamics Simulation , Molecular Structure , Nucleic Acid Conformation , RNA, Viral/genetics , SARS-CoV-2/chemistry
3.
Monatsschr Kinderheilkd ; 169(4): 317-321, 2021.
Article in German | MEDLINE | ID: covidwho-1141398

ABSTRACT

The boy of Egyptian origin was previously healthy. After a history of fever for 7 days, abdominal pain, vomiting and dry cough resistant to treatment with oral antibiotics, he was admitted to hospital. The clinical examination showed a slightly red throat, a tense abdomen and erythema. The blood tests revealed leukocytosis and significantly increased inflammatory parameters. The abdominal ultrasound showed thickened intestinal loops in the left lower abdomen and the echocardiography showed minimal mitral regurgitation, a narrow pericardial effusion lamella over both ventricles and normal coronary arteries. Accordingly, cardiac enzymes were elevated. The day after admission, the boy developed an increasing rash and was transferred to the PICU because of septic shock refractory to high volume resuscitation, requiring hemodynamic support with noradrenaline and noninvasive respiratory assistance. The initial testing for SARS-CoV­2 on nasopharyngeal aspirates was negative twice; however, serum IgG antibodies were positive. Other viral and bacterial infections were excluded as the cause of the symptoms.The patient received IVIG, ASS, furosemide and methylprednisolone and the antibiotic treatment was continued. The dosage of the catecholamine could be reduced according to the patient's condition and the serially performed echocardiographic findings. The patient recovered in his general condition and was discharged from the PICU after 8 days. With the help of a detailed family history, we were able to figure out that the whole family, including the patient himself, had symptoms of a cold about 1 month earlier. Hence, SARS-CoV­2 antibody tests carried out showed a positive result for all of them.Pediatric inflammatory multisystem syndrome (PIMS) can quickly lead to manifest shock symptoms, necessitating close monitoring. A PICU background is crucial to treat possibly occurring symptoms and complications. High-dose steroids are used therapeutically alongside supportive therapies.

4.
J Clean Prod ; 296: 126460, 2021 May 10.
Article in English | MEDLINE | ID: covidwho-1118535

ABSTRACT

With the ongoing global pandemic due to Coronavirus (COVID-19), the use of personal protective equipment (PPE), specifically single-use surgical masks, have been on a sharp incline. Currently, many countries are experiencing second and third waves of COVID-19 and as such have resorted to making face masks a mandatory requirement. The repercussions of this have resulted in millions of single-use face masks being discharged into the environment, washing up on beaches, floating beneath oceans and ending up in vulnerable places. The global pandemic has not only affected the economy and health of the world's population but now is seriously threatening the natural environment. The main plastic in single-use face masks is polypropylene which in landfill can take more than 25 years to break down. This paper explores an innovative way to use pandemic waste in concrete construction with the main focus on single-use face masks. Single-use masks have been cut-up by first removing the ear loops and inner nose wire to size and spread throughout five different mix designs to explore the possible benefits and uses within concrete. The masks were introduced by volume at 0% (control), 0.10%, 0.15%, 0.20% and 0.25% with testing focusing on compressive strength, indirect tensile strength, modulus of elasticity and ultrasonic pulse velocity to test the overall quality of the concrete. The introduction of the single-use face masks led to an increase in the strength properties of the concrete samples, as well as an increase in the overall quality of the concrete. However, beyond 0.20%, the trend of increasing strength began to decrease.

5.
Maedica (Bucur) ; 15(4): 561-562, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1090085

ABSTRACT

We present a case of Koebner phenomenon induced by friction due to tightness of ear loops attached to the face mask used as protective measure against spreading COVID-19 infection.

6.
Pediatr Infect Dis J ; 40(2): e82-e83, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-968321

ABSTRACT

We report findings on abdominal imaging in critically ill children admitted with MIS-C. On sonography, hepatomegaly, nephromegaly, gallbladder wall edema, ascites, intestinal inflammation and mesenteric lymphadenopathy were seen, while CT showed fluid-filled small bowel loops, mural thickening of the terminal ileum, diffuse lymphadenopathy, and moderate ascites.


Subject(s)
Abdomen/diagnostic imaging , COVID-19/diagnostic imaging , Inflammation/diagnostic imaging , Adolescent , Ascites/diagnostic imaging , COVID-19/physiopathology , COVID-19/therapy , Child , Child, Preschool , Critical Illness , Female , Gallbladder Diseases/diagnostic imaging , Hepatomegaly/diagnostic imaging , Humans , Ileum/diagnostic imaging , Infant , Inflammation/drug therapy , Inflammation/physiopathology , Intestine, Small/diagnostic imaging , Kidney Diseases/diagnostic imaging , Lymphadenopathy/diagnostic imaging , Male , Mesenteric Lymphadenitis/diagnostic imaging , Mucocutaneous Lymph Node Syndrome/diagnostic imaging , SARS-CoV-2 , Ultrasonography
7.
JAMA Intern Med ; 181(4): 463-469, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-966088

ABSTRACT

Importance: During the coronavirus disease 2019 (COVID-19) pandemic, the general public has been advised to wear masks or improvised face coverings to limit transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, there has been considerable confusion and disagreement regarding the degree to which masks protect the wearer from airborne particles. Objectives: To evaluate the fitted filtration efficiency (FFE) of various consumer-grade and improvised face masks, as well as several popular modifications of medical procedure masks that are intended to improve mask fit or comfort. Design, Setting, and Participants: For this study conducted in a research laboratory between June and August 2020, 7 consumer-grade masks and 5 medical procedure mask modifications were fitted on an adult male volunteer, and FFE measurements were collected during a series of repeated movements of the torso, head, and facial muscles as outlined by the US Occupational Safety and Health Administration Quantitative Fit Testing Protocol. The consumer-grade masks tested included (1) a 2-layer nylon mask with ear loops that was tested with an optional aluminum nose bridge and filter insert in place, (2) a cotton bandana folded diagonally once (ie, "bandit" style) or in a (3) multilayer rectangle according to the instructions presented by the US Surgeon General, (4) a single-layer polyester/nylon mask with ties, (5) a polypropylene mask with fixed ear loops, (6) a single-layer polyester gaiter/neck cover balaclava bandana, and (7) a 3-layer cotton mask with ear loops. Medical procedure mask modifications included (1) tying the mask's ear loops and tucking in the side pleats, (2) fastening ear loops behind the head with 3-dimensional-printed ear guards, (3) fastening ear loops behind the head with a claw-type hair clip, (4) enhancing the mask/face seal with rubber bands over the mask, and (5) enhancing the mask/face seal with a band of nylon hosiery over the fitted mask. Main Outcomes and Measures: The primary study outcome was the measured FFE of common consumer-grade and improvised face masks, as well as several popular modifications of medical procedure masks. Results: The mean (SD) FFE of consumer grade masks tested on 1 adult male with no beard ranged from 79.0% (4.3%) to 26.5% (10.5%), with the 2-layer nylon mask having the highest FFE. Unmodified medical procedure masks with ear loops had a mean (SD) FFE of 38.5% (11.2%). All modifications evaluated in this study increased procedure mask FFE (range [SD], 60.3% [11.1%] to 80.2% [3.1%]), with a nylon hosiery sleeve placed over the procedure mask producing the greatest improvement. Conclusions and Relevance: While modifications to improve medical procedure mask fit can enhance the filtering capability and reduce inhalation of airborne particles, this study demonstrates that the FFEs of consumer-grade masks available to the public are, in many cases, nearly equivalent to or better than their non-N95 respirator medical mask counterparts.


Subject(s)
COVID-19/prevention & control , COVID-19/transmission , Masks , Adult , Cotton Fiber , Equipment Design , Filtration/instrumentation , Humans , Male , Nylons , Polyesters , Polypropylenes , Protective Clothing
8.
mBio ; 11(6)2020 10 30.
Article in English | MEDLINE | ID: covidwho-894828

ABSTRACT

The ultimate outcome of the coronavirus disease 2019 (COVID-19) pandemic is unknown and is dependent on a complex interplay of its pathogenicity, transmissibility, and population immunity. In the current study, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was investigated for the presence of large-scale internal RNA base pairing in its genome. This property, termed genome-scale ordered RNA structure (GORS) has been previously associated with host persistence in other positive-strand RNA viruses, potentially through its shielding effect on viral RNA recognition in the cell. Genomes of SARS-CoV-2 were remarkably structured, with minimum folding energy differences (MFEDs) of 15%, substantially greater than previously examined viruses such as hepatitis C virus (HCV) (MFED of 7 to 9%). High MFED values were shared with all coronavirus genomes analyzed and created by several hundred consecutive energetically favored stem-loops throughout the genome. In contrast to replication-associated RNA structure, GORS was poorly conserved in the positions and identities of base pairing with other sarbecoviruses-even similarly positioned stem-loops in SARS-CoV-2 and SARS-CoV rarely shared homologous pairings, indicative of more rapid evolutionary change in RNA structure than in the underlying coding sequences. Sites predicted to be base paired in SARS-CoV-2 showed less sequence diversity than unpaired sites, suggesting that disruption of RNA structure by mutation imposes a fitness cost on the virus that is potentially restrictive to its longer evolution. Although functionally uncharacterized, GORS in SARS-CoV-2 and other coronaviruses represents important elements in their cellular interactions that may contribute to their persistence and transmissibility.IMPORTANCE The detection and characterization of large-scale RNA secondary structure in the genome of SARS-CoV-2 indicate an extraordinary and unsuspected degree of genome structural organization; this could be effectively visualized through a newly developed contour plotting method that displays positions, structural features, and conservation of RNA secondary structure between related viruses. Such RNA structure imposes a substantial evolutionary cost; paired sites showed greater restriction in diversity and represent a substantial additional constraint in reconstructing its molecular epidemiology. Its biological relevance arises from previously documented associations between possession of structured genomes and persistence, as documented for HCV and several other RNA viruses infecting humans and mammals. Shared properties potentially conferred by large-scale structure in SARS-CoV-2 include increasing evidence for prolonged infections and induced immune dysfunction that prevents development of protective immunity. The findings provide an additional element to cellular interactions that potentially influences the natural history of SARS-CoV-2, its pathogenicity, and its transmission.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/virology , Coronavirus/genetics , Pneumonia, Viral/virology , RNA, Viral/chemistry , RNA, Viral/genetics , Animals , Base Sequence , COVID-19 , Evolution, Molecular , Genome, Viral , Humans , Nucleic Acid Conformation , Pandemics , SARS-CoV-2 , Sequence Alignment
9.
3D Print Med ; 6(1): 27, 2020 Sep 29.
Article in English | MEDLINE | ID: covidwho-802427

ABSTRACT

PURPOSE: Many commonly used mask designs are secured by elastic straps looping around the posterior auricular region. This constant pressure and friction against the skin may contribute to increased wearer pain, irritation, and discomfort. The purpose of this work is to report a modified 3D printed mask extender to alleviate discomfort and increase mask wearability by relieving posterior auricular pressure from isolation masks. METHODS: Our institutional review board designated this project as non-human research and exempt. As part of resourcing 3D printing laboratories along with individual 3D printers to provide resources to healthcare workers, mask extenders were printed to relieve posterior auricular pressure from individuals wearing isolation masks. The authors modifed an existing mask extender, increasing its length with accompanying peripheral rungs for isolation mask securement. 3D printing was performed with Ultimaker S5 (Ultimaker B.V.; Geldermalsen, Netherlands) and CR-10 (Creality3D; Shenzhen, China) 3D printers using polylactic acid filaments. The author's modified extended mask extenders were printed and freely delivered to healthcare workers (physicians, nurses, technologists, and other personnel) at the authors' institution. RESULTS: The final mask extender design was printed with the two 3D printers with a maximum 7 straps printed simultaneously on each 3D printer. Mean print times ranges from 105 min for the Ultimaker S5 printer and 150 min for the CR-10. Four hundred seventy-five mask extenders were delivered to healthcare workers at the authors' institution, with the demand far exceeding the available supply. CONCLUSION: We offer a modification of a 3D printed mask extender design that decreases discomfort and increases the wearability of isolation mask designs with ear loops thought to relieve posterior auricular skin pressure and ability to control strap tension. The design is simple, produced with inexpensive material (polylactic acid), and have been well-received by healthcare providers at our institution.

10.
Sci Total Environ ; 752: 142259, 2021 Jan 15.
Article in English | MEDLINE | ID: covidwho-752863

ABSTRACT

Currently, there is no effective vaccine for tackling the ongoing COVID-19 pandemic caused by SARS-CoV-2 with the occurrence of repeat waves of infection frequently stretching hospital resources beyond capacity. Disease countermeasures rely upon preventing person-to-person transmission of SARS-CoV2 so as to protect front-line healthcare workers (HCWs). COVID-19 brings enormous challenges in terms of sustaining the supply chain for single-use-plastic personal and protective equipment (PPE). Post-COVID-19, the changes in medical practice will drive high demand for PPE. Important countermeasures for preventing COVID-19 transmission include mitigating potential high risk aerosol transmission in healthcare setting using medical PPE (such as filtering facepiece respirators (FFRs)) and the appropriate use of face coverings by the general public that carries a lower transmission risk. PPE reuse is a potential short term solution during COVID-19 pandemic where there is increased evidence for effective deployment of reprocessing methods such as vaporized hydrogen peroxide (30 to 35% VH2O2) used alone or combined with ozone, ultraviolet light at 254 nm (2000 mJ/cm2) and moist heat (60 °C at high humidity for 60 min). Barriers to PPE reuse include potentially trust and acceptance by HCWs. Efficacy of face coverings are influenced by the appropriate wearing to cover the nose and mouth, type of material used, number of layers, duration of wearing, and potentially superior use of ties over ear loops. Insertion of a nose clip into cloth coverings may help with maintaining fit. Use of 60 °C for 60 min (such as, use of domestic washing machine and spin dryer) has been advocated for face covering decontamination. Risk of virus infiltration in improvised face coverings is potentially increased by duration of wearing due to humidity, liquid diffusion and virus retention. Future sustained use of PPE will be influenced by the availability of recyclable PPE and by innovative biomedical waste management.


Subject(s)
Coronavirus Infections , Coronavirus , Pandemics , Pneumonia, Viral , Waste Management , Betacoronavirus , COVID-19 , Humans , Pandemics/prevention & control , SARS-CoV-2
11.
Int J Mol Sci ; 21(17)2020 Aug 27.
Article in English | MEDLINE | ID: covidwho-737661

ABSTRACT

A considerable amount of rapid-paced research is underway to combat the SARS-CoV-2 pandemic. In this work, we assess the 3D structure of the 5' untranslated region of its RNA, in the hopes that stable secondary structures can be targeted, interrupted, or otherwise measured. To this end, we have combined molecular dynamics simulations with previous Nuclear Magnetic Resonance measurements for stem loop 2 of SARS-CoV-1 to refine 3D structure predictions of that stem loop. We find that relatively short sampling times allow for loop rearrangement from predicted structures determined in absence of water or ions, to structures better aligned with experimental data. We then use molecular dynamics to predict the refined structure of the transcription regulatory leader sequence (TRS-L) region which includes stem loop 3, and show that arrangement of the loop around exchangeable monovalent potassium can interpret the conformational equilibrium determined by in-cell dimethyl sulfate (DMS) data.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/virology , Pneumonia, Viral/virology , 5' Untranslated Regions/genetics , COVID-19 , Humans , Inverted Repeat Sequences/genetics , Molecular Dynamics Simulation , Nucleic Acid Conformation , Pandemics , RNA, Viral/genetics , SARS-CoV-2
12.
Retina ; 40(9): 1651-1656, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-682169

ABSTRACT

PURPOSE: To investigate the safety of face masks worn by patients during intravitreal injections. METHODS: A prospective, qualitative, interventional study performed in a tertiary university hospital. Healthy volunteers were asked to wear three different professional surgical face masks while air leaks around the eyes were monitored. Three types of masks were investigated as follows: 1) surgical face mask with four tying strips, 2) surgical face mask with elastic ear loops and 3) 2200 N95 tuberculosis particulate face mask. For each session the periocular area was inspected for air leak during normal respiration, speech, and deep respiration. Detection of air leak was performed using the following two professional thermal cameras: FLIR A310-thermal camera and EyeCGas 2.0-super sensitive infrared camera used for detection of minute fugitive emissions of industrial gases. RESULTS: Ten healthy volunteers were enrolled in this study. The experiment was repeated 45 times for each camera; 3 times for each of 3 mask types, on 5 volunteers, for a total of 90 trials. Air jets were detected originating from the superior edges of the masks radiating toward the eyes in 81% (73/90) of cases in total; 71% (32/45) with the FLIR camera and 91% (41/45) with the OPGAL camera. Air leaks were detected with all investigated mask types. CONCLUSION: Patients wearing face masks during intravitreal injections may be at a higher risk of endophthalmitis. Until further data are available, we recommend verifying proper face mask fitting and either taping the upper edges of the face masks with a medical adhesive tape or using an adhesive surgical drape around the injected eye.


Subject(s)
Endophthalmitis/epidemiology , Eye Infections, Bacterial/epidemiology , Intravitreal Injections , Masks/adverse effects , Surgical Wound Infection/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Endophthalmitis/microbiology , Eye Infections, Bacterial/microbiology , Healthy Volunteers , Humans , Middle Aged , Prospective Studies , Risk Factors , Surgical Wound Infection/microbiology , Thermography/methods , Young Adult
13.
Sci Rep ; 10(1): 12331, 2020 07 23.
Article in English | MEDLINE | ID: covidwho-676846

ABSTRACT

The outbreak of COVID-19 has brought great threat to human health. Its causative agent is a severe acute respiratory syndrome-related coronavirus which has been officially named SARS-CoV-2. Here we report the discovery of extremely low CG abundance in its open reading frames. We found that CG reduction in SARS-CoV-2 is achieved mainly through mutating C/G into A/T, and CG is the best target for mutation. Meanwhile, 5'-untranslated region of SARS-CoV-2 has high CG content and is capable of forming an internal ribosome entry site (IRES) to recruit host ribosome for translating its RNA. These features allow SARS-CoV-2 to reproduce efficiently in host cells, because less energy is consumed in disrupting the stem-loops formed by its genomic RNA. Notably, genomes of cellular organisms also have very low CG abundance, suggesting that mutating C/G into A/T occurs universally in all life forms. Moreover, CG is the dinucleotide related to CpG island, mutational hotspot and single nucleotide polymorphism in cellular organisms. The relationship between these features is worthy of further investigations.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/virology , Dinucleoside Phosphates/metabolism , Open Reading Frames/genetics , Pneumonia, Viral/virology , 5' Untranslated Regions , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/pathology , CpG Islands , Humans , Nucleic Acid Conformation , Odds Ratio , Pandemics , Pneumonia, Viral/pathology , Polymorphism, Single Nucleotide , SARS-CoV-2 , Virus Replication
14.
Aesthetic Plast Surg ; 44(5): 1947-1950, 2020 10.
Article in English | MEDLINE | ID: covidwho-603953

ABSTRACT

In this period of the Covid-19 pandemic, a protective mask has become a common object of use to contain virus transmission. The imminent need for masks has led many governments to produce them, including surgical masks with elastic loops or masks with side cuts at the ears. Among those on the market, surgical masks with elastic loops are the ones most chosen by parents for their children. These elastics cause constant compression on the skin and, consequently, on the cartilage of the auricle, leading to erythematous and painful lesions of the retroauricular skin when the masks are used for many hours a day. Pre-adolescent children have undeveloped auricular cartilage with less resistance to deformation; prolonged pressure from the elastic loops of the mask at the hollow or, even worse, at the anthelix level can influence the correct growth and angulation of the outer ear. In fact, unlike when using conservative methods for the treatment of protruding ears, this prolonged pressure can increase the cephaloauricular angle of the outer auricle. It is important for the authorities supplying the masks to be aware of this potential risk and for alternative solutions to be found while maintaining the possibility of legitimate prevention of the potential spread of the virus.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266 .


Subject(s)
Coronavirus Infections/prevention & control , Ear Auricle/abnormalities , Masks/adverse effects , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Age Factors , COVID-19 , Child , Child, Preschool , Coronavirus Infections/epidemiology , Equipment Design , Equipment Safety , Female , Humans , Male , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Primary Prevention/methods
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