Acad Sci Research Articles

PPE for SARS-Cov-2 and the utility of single-use aprons

Journal of Paramedic PracticeVol. 13, No. 10 CommentPPE for SARS-Cov-2 and the utility of single-use apronsWesley HowarthWesley HowarthEmail for correspondence: E-mail Address: [email protected].Paramedic, North West Ambulance Service NHS Trust, Bolton, UKSearch for more papers by this authorWesley HowarthPublished Online:5 Oct 2021https://doi.org/10.12968/jpar.2021.13.10.431AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Brown J, Gregson FKA, Shrimpton A et al.. A quantitative evaluation of aerosol generation during tracheal intubation and extubation. Anaesthesia. 2020. https://doi.org/10.1111/anae.15292 Google ScholarCenters for Disease Control and Prevention. Emergency considerations for PPE. 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/non-us-settings/emergency-considerations-ppe.html#ppe-specific-strategies (accessed 26 September 2021) Google ScholarChin A, Chu J, Perera M et al.. Stability of SARS-CoV-2 in different environmental conditions. 2020. https://doi.org/10.1016/S2666-5247(20)30003-3 Google ScholarEuropean Centre for Disease Prevention and Control. Transmission of COVID-19. 2021. https://www.ecdc.europa.eu/en/covid-19/latest-evidence/transmission (accessed 26 September 2021) Google ScholarEuropean Centre for Disease Prevention and Control. Guidance for wearing and removing personal protective equipment in healthcare settings for the care of patients with suspected or confirmed COVID-19. 2020. https://www.ecdc.europa.eu/en/publications-data/guidance-wearing-and-removing-personal-protective-equipment-healthcare-settings (accessed 26 September 2021) Google ScholarGuo YP, Li Y, Wong PL. Environment and body contamination: a comparison of two different removal methods in three types of personal protective clothing. Am J Infect Control. 2014;42(4):e39–e45. https://doi.org/10.1016/j.ajic.2013.12.021 Crossref, Google ScholarHall S, Poller B, Bailey C et al.. Use of ultraviolet-fluorescence-based simulation in evaluation of personal protective equipment worn for first assessment and care of a patient with suspected high-consequence infectious disease. J Hosp Infect. 2018;99(2):218–228. https://doi.org/10.1016/j.jhin.2018.01.002 Crossref, Google ScholarHoward-Jones A, Almuzam S, Britton P et al.. Should I be worried about carrying the virus that causes COVID-19 home on my clothes? J Paediatr Child Health. 2020;56:980. https://doi.org/10.1111/jpc.14938 Crossref, Google ScholarIslam MS, Rahman KM, Sun Y et al.. Current knowledge of COVID-19 and infection prevention and control strategies in healthcare settings: A global analysis. Infect Control Hosp Epidemiol. 2020;41:1196-1206. https://doi.org/10.1017/ice.2020.237 Crossref, Google ScholarJavid B, Weekes MP, Matheson NJ. Covid-19: should the public wear face masks?. Br Med J. 2020;369. https://doi.org/10.1136/bmj.m1442 Google ScholarLoveday HP, Wilson JA, Pratt RJ et al.. National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. J Hosp Infect. 2014;86 (Suppl 1):S1–S70. https://doi.org/10.1016/S0195-6701(13)60012-2 Crossref, Google ScholarNational Institute for Health and Care Excellence. Healthcare-associated infections. 2019. https://cks.nice.org.uk/topics/healthcare-associated-infections/ (accessed 26 September 2021) Google ScholarPublic Health England. Guidance COVID-19: guidance for Ambulance Trusts. 2020. https://www.gov.uk/government/publications/covid-19-guidance-for-ambulance-trusts/covid-19-guidance-for-ambulance-trusts (accessed 26 September 2021) Google ScholarPublic Health England. COVID-19: infection prevention and control (IPC). 2021. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/954690/Infection_Prevention_and_Control_Guidance_January_2021.pdf (accessed 26 September 2021) Google ScholarTang S, Mao Y, Jones RM et al.. Aerosol transmission of SARS-CoV-2? Evidence, prevention and control. Environ Int. 2020;144. https://doi.org/10.1016/j.envint.2020.106039 Google ScholarVerbeek JH, Rajamaki B, Ijaz S et al.. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2020;5:CD011621. https://doi.org/10.1002/14651858.CD011621.pub5 Google ScholarWilson JA, Loveday HP, Hoffman PN, Pratt RJ. 2007. Uniform: an evidence review of the microbiological significance of uniforms and uniform policy in the prevention and control of healthcare-associated infections. Report to the Department of Health (England). J Hosp Infect. 2007;66: 301–307. https://doi.org/10.1016/j.jhin.2007.03.026 Crossref, Google ScholarWilson N, Corbett S, Tovey E. Airborne transmission of covid-19. BMJ. 2020;370:m3206. https://doi.org/110.1136/bmj.m3206 Crossref, Google ScholarWorld Health Organization. Coronavirus disease (COVID-19): Masks. 2020a. https://tinyurl.com/4yamn2ra (accessed 26 September 2021) Google ScholarWorld Health Organization. Transmission of SARS-CoV-2: implications for infection prevention precautions. 2020b. https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions (accessed 26 September 2021) Google ScholarWorld Health Organization. Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. 2020c. https://www.who.int/publications/i/item/10665-331495 (accessed 26 September 2021) Google ScholarZhang R, Li Y, Zhang A, Wang Y, Molina M. Identifying airborne transmission as the dominant route for the spread of COVID-19. Proc Nat Acad Sci. 2020;117(26):14857-14863. https://doi.org/10.1073/pnas.2009637117 Crossref, Google Scholar FiguresReferencesRelatedDetailsCited byLettersSammer Tang, Kirsty Morgan, Sian Cowell, Deborah Bullock9 November 2021 | Journal of Paramedic Practice, Vol. 13, No. 11 2 October 2021Volume 13Issue 10ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 5 October 2021 Published in print 2 October 2021 Information© MA Healthcare LimitedPDF download

A CASE REPORT ON EXTENSIVE ARTERIAL THROMBOSIS AS A COMPLICATION OF COVID-19 INFECTION

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Coronavirus disease (COVID-19) is a global health crisis. It is associated with increased activation of the clotting system leading to thrombotic complications in 5 to 23% of cases[1]. It is known to cause significant venous thromboembolism and few cases with arterial thrombosis with increased risk of life-threatening complications like myocardial infarction, ischemic stroke, splenic infarct, and left ventricular clot have been reported[2]. CASE PRESENTATION: A 70-year-old female with a past medical history of coronary artery disease, Hypertension, COPD, recent COVID-19 (3 weeks ago) not requiring admission to hospital presented to the hospital with bilateral leg and forearm pain. Leg pain was worse with activity. She had feeble peripheral pulses on palpation.She underwent Computed Tomography angiography which showed extensive arterial thrombosis involving the distal abdominal aorta, left common iliac artery, superior mesenteric artery, and also showed an area of wedge-shaped infarction in the spleen. She had a thrombus at the apex of the left ventricle, with incidental 1.3 cm spiculated mass in the left lung. There was no evidence of venous thromboembolism in imaging.She was started on therapeutic anticoagulation with heparin. After multidisciplinary discussion with Hematology, Vascular surgery, and Cardiology, her anticoagulation was changed to Enoxaparin. She was managed medically. Workup including JAK2, beta-2 glycoprotein antibodies, lupus anticoagulant, and anticardiolipin antibodies was negative. DISCUSSION: The exact mechanisms that activate coagulation cascade in SARS-CoV-2 infection are still unknown, but they are found to be associated with increased thrombogenesis. SARS-CoV-2 viral infection can activate the plasmatic clotting system by activating multiple procoagulant pathways. Angiotensin-converting enzymes 2 are normally found on various cells such as lymphocytes, alveolar cells, monocytes/macrophages, and platelets. In SARS-CoV-2 infection, Surface S protein of SARS-CoV-2 binds to its target transmembrane receptor( ACE2 protein) and down-regulates the expression of ACE2 protein. It leads to the accumulation of angiotensin II in the body which interacts with platelets and endothelial cells leading to further promotion of clot formation[3]. This was the likely cause of hypercoagulable state in our patient leading to thrombosis. CONCLUSIONS: An extensive arterial clot can be the initial presentation in COVID-19 patients and can be treated promptly with anticoagulation. Early introduction of prophylactic anticoagulation is necessary to prevent clot formation. REFERENCE #1:.Thromboinflammation and the hypercoagulability of COVID-19. Connors JM, Levy JH J Thromb Haemost.2020 Jul;18(7):1559-1561. REFERENCE #2: Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV, and lessonsfrom the past.Giannis D, Ziogas IA, Gianni P J Clin Virol. 2020 Jun;127():104362. REFERENCE #3: Smith S A, Mutch N J, Baskar D, Rohloff P, Docampo R, Morrissey J H. Polyphosphate modulates bloodcoagulation and fibrinolysis. Proc Natl Acad Sci U S A. 2006;103(04):903–908. DISCLOSURES: No relevant relationships by Sumit Gami, source=Web Response No relevant relationships by Subash Ghimire, source=Web Response No relevant relationships by Sushmita Khadka, source=Web Response No relevant relationships by Shobha Mandal, source=Web Response

Historical aspects of muscle research in the Dubowitz Neuromuscular Centre: the Hammersmith days

Historical aspects of muscle research in the Dubowitz Neuromuscular Centre: the Hammersmith days

Mobility data to aid assessment of human responses to extreme environmental conditions

Mobility data to aid assessment of human responses to extreme environmental conditions

Advancing racial and ethnic equity in science, medicine, and health: a call for papers

Advancing racial and ethnic equity in science, medicine, and health: a call for papers

The Lancet Commission on water, sanitation and hygiene, and health

The Lancet Commission on water, sanitation and hygiene, and health

Historical Features Regarding the Neuropathic Outbreaks in Brazilian Troops in the Paraguayan War.

During the Paraguayan War, Brazilian army and navy officers attributed outbreaks of combatant limb weakness with particular features such as tingling to palustrian causes. A dietary basis was not fully suspected at the time, and the popular name beriberi had not been coined. During wartime, there was a shortage in the food supply in addition to poor environmental conditions and diarrheal diseases, and many reports of "palustrian cachexia" were made. There are also reports of the use of native flora to feed troops, as well as alcoholism. There are also accounts of the death of horses with symptoms similar to those of combatants. It was reported that black soldiers were more resistant to "palustrian cachexia." This article presents the disease ecology and clinical manifestations of beriberi at wartime, linked to starvation and consumption of pickled food and native flora. These military explorations and operations in the Paraguayan War happened more than 150 y ago and present some aspects of wilderness medicine in the past.

Institutional imperatives for the advancement of women in medicine and science through the COVID-19 pandemic

Institutional imperatives for the advancement of women in medicine and science through the COVID-19 pandemic

Myelin densities in retinotopically defined dorsal visual areas of the macaque

The visuotopic organization of dorsal visual cortex rostral to area V2 in primates has been a longstanding source of controversy. Using sub-millimeter phase-encoded retinotopic fMRI mapping, we recently provided evidence for a surprisingly similar visuotopic organization in dorsal visual cortex of macaques compared to previously published maps in New world monkeys (Zhu and Vanduffel, Proc Natl Acad Sci USA 116:2306–2311, 2019). Although individual quadrant representations could be robustly delineated in that study, their grouping into hemifield representations remains a major challenge. Here, we combined in-vivo high-resolution myelin density mapping based on MR imaging (400 µm isotropic resolution) with fine-grained retinotopic fMRI to quantitatively compare myelin densities across retinotopically defined visual areas in macaques. Complementing previously documented differences in populational receptive-field (pRF) size and visual field signs, myelin densities of both quadrants of the dorsolateral posterior area (DLP) and area V3A are significantly different compared to dorsal and ventral area V3. Moreover, no differences in myelin density were observed between the two matching quadrants belonging to areas DLP, V3A, V1, V2 and V4, respectively. This was not the case, however, for the dorsal and ventral quadrants of area V3, which showed significant differences in MR-defined myelin densities, corroborating evidence of previous myelin staining studies. Interestingly, the pRF sizes and visual field signs of both quadrant representations in V3 are not different. Although myelin density correlates with curvature and anticorrelates with cortical thickness when measured across the entire cortex, exactly as in humans, the myelin density results in the visual areas cannot be explained by variability in cortical thickness and curvature between these areas. The present myelin density results largely support our previous model to group the two quadrants of DLP and V3A, rather than grouping DLP- with V3v into a single area VLP, or V3d with V3A+ into DM.

Behaviorally and environmentally induced non-24-hour sleep-wake rhythm disorder in sighted patients.

To determine whether there was evidence of circadian or sleep-regulatory dysfunction in sighted individuals with non-24-hour sleep-wake rhythm disorder. Three sighted individuals with signs and/or symptoms of non-24-hour sleep-wake rhythm disorder were studied. Thirty-five- to 332-day laboratory and home-based assessments of sleep-wake and circadian timing, endogenous circadian period, photic input to the circadian pacemaker, and/or circadian and sleep-wake-dependent regulation of sleep were conducted. No evidence of circadian dysfunction was found in these individuals. Instead, sleep-wake timing appeared to dissociate from the circadian timing system, and/or self-selected sleep-wake and associated light/dark timing shifted the circadian pacemaker later, rather than the circadian pacemaker determining sleep-wake timing. These findings suggest that the etiology of this disorder may be light- and/or behaviorally induced in some sighted people, which has implications for the successful treatment of this disorder. Emens JS, St Hilaire MA, Klerman EB, etal. Behaviorally and environmentally induced non-24-hour sleep-wake rhythm disorder in sighted patients. J Clin Sleep Med. 2022;18(2):453-459.

State dependent effects on the frequency response of prestin\u2019s real and imaginary components of nonlinear capacitance

The outer hair cell (OHC) membrane harbors a voltage-dependent protein, prestin (SLC26a5), in high density, whose charge movement is evidenced as a nonlinear capacitance (NLC). NLC is bell-shaped, with its peak occurring at a voltage, Vh, where sensor charge is equally distributed across the plasma membrane. Thus, Vh provides information on the conformational state of prestin. Vh is sensitive to membrane tension, shifting to positive voltage as tension increases and is the basis for considering prestin piezoelectric (PZE). NLC can be deconstructed into real and imaginary components that report on charge movements in phase or 90 degrees out of phase with AC voltage. Here we show in membrane macro-patches of the OHC that there is a partial trade-off in the magnitude of real and imaginary components as interrogation frequency increases, as predicted by a recent PZE model (Rabbitt in Proc Natl Acad Sci USA 17:21880–21888, 2020). However, we find similar behavior in a simple 2-state voltage-dependent kinetic model of prestin that lacks piezoelectric coupling. At a particular frequency, Fis, the complex component magnitudes intersect. Using this metric, Fis, which depends on the frequency response of each complex component, we find that initial Vh influences Fis; thus, by categorizing patches into groups of different Vh, (above and below − 30 mV) we find that Fis is lower for the negative Vh group. We also find that the effect of membrane tension on complex NLC is dependent, but differentially so, on initial Vh. Whereas the negative group exhibits shifts to higher frequencies for increasing tension, the opposite occurs for the positive group. Despite complex component trade-offs, the low-pass roll-off in absolute magnitude of NLC, which varies little with our perturbations and is indicative of diminishing total charge movement, poses a challenge for a role of voltage-driven prestin in cochlear amplification at very high frequencies.

Understanding why superspreading drives the COVID-19 pandemic but not the H1N1 pandemic

Understanding why superspreading drives the COVID-19 pandemic but not the H1N1 pandemic

Stable and self-consistent charged gravastar model within the framework of f(R,,T) gravity

In this work, we discuss the configuration of a gravastar (gravitational vacuum stars) in the context of f(R, ,T ) gravity by employing the Mazur–Mottola conjecture (Mazur and Mottola in Report No. LA-UR-01-5067, 2001; Mazur and Mottola, Proc Natl Acad Sci USA 101:9545, 2004). The gravastar is conceptually a substitute for a black hole theory as available in the literature and it has three regions with different equation of states. By assuming that the gravastar geometry admits a conformal Killing vector, the Einstein–Maxwell field equations have been solved in different regions of the gravastar by taking a specific equation of state as proposed by Mazur and Mottola. We match our interior spacetime to the exterior spherical region which is completely vacuum and described by the Reissner–Nordström geometry. For the particular choice of f(R,,T) of f(R, ,T )=R+2gamma T, here we analyze various physical properties of the thin shell and also present our results graphically for these properties. The stability analysis of our present model is also studied by introducing a new parameter eta and we explore the stability regions. Our proposed gravastar model in the presence of charge might be treated as a successful stable alternative of the charged black hole in the context of this version of gravity.

A bibliometric analysis of the research on hematological tumor microenvironment.

BackgroundIn recent years, the incidence of hematological tumors has increased. The tumor microenvironment (TME) is the local biological environment in the process of tumor occurrence and development and is closely related to hematological malignancies, including lymphoma and leukemia. This study aims to conduct a bibliometric analysis of the research on the hematological TME, reflect the general situation of the research in this field, and remind the focus of future research.MethodsSearch the Science Citation Index Expanded (SCI-E) database on the Web of Science Core Collection (WOSCC). Use subject terms to search tumor microenvironment; the limited search subject is Hematology, and the time range is from 1990 to July 18, 2021. Use CiteSpace software to analyze the number of annual papers published, the number of citations, the distribution of disciplines, the distribution of countries/institutions, the distribution of authors, the distribution of journals, and the frequency of use of keywords and its trend of change.ResultsThere were 1,992 related research articles cited 77,213 times. The top 5 countries with the number of published papers in this field are: the United States, Italy, China, Germany, and the United Kingdom; the top 5 centrally ranked countries are the United States, Italy, Spain, France, and Japan. Literature and cooperation are mainly from the United States. The top three researchers with several published papers are Anderson KC, Ansell SM, and Gascoyne RD. Their centrality scores are all low, with only 5 researchers reaching above 0.01, and there is less collaboration between the authors. High-quality papers are from Blood, Cancer Res, P Natl Acad Sci USA, and Nature. Keyword analysis shows that immunotherapy is the current focus of research in this field.ConclusionsThe research on the microenvironment of hematological malignancies is rapidly developing. At present, the main research focus is on targeted immunotherapy.

Can we talk about myoblast fusion?

Can we talk about myoblast fusion?

Measuring Droplets Expelled During Endoscopy to Investigate COVID-19 Transmission Risk

Measuring Droplets Expelled During Endoscopy to Investigate COVID-19 Transmission Risk

Murine models of Duchenne muscular dystrophy: is there a best model?

Murine models of Duchenne muscular dystrophy: is there a best model?

Hamiltonicity of a Coprime Graph

The k-coprime graph of order n is the graph with vertex set \(\{k, k+1, \ldots , k+n-1\}\) in which two vertices are adjacent if and only if they are coprime. We characterize Hamiltonian k-coprime graphs. As a particular case, two conjectures by Tout et al. (Natl Acad Sci Lett 11:365–368, 1982) and by Schroeder (Graph Comb 38:119–140, 2019) on prime labeling of 2-regular graphs follow. A prime labeling of a graph with n vertices is a labeling of its vertices with distinct integers from \(\{1, 2,\ldots , n\}\) in such a way that the labels of any two adjacent vertices are relatively prime.

Abstract 1234: G4 binders as potential immunostimulatory compounds for cancer therapy

Abstract G-quadruplex (G4) is non-canonical nucleic acid structure involved in a plethora of fundamental biological processes. In past decades, it has been studied as a promising pharmaceutical target for anticancer therapy. However, no G4-targeting agent has shown significant clinical effects up to date. Pyridostatin (PDS), a well-known G4 binder, can induce double-stranded DNA breaks and genome instability. We have recently shown that PDS and other G4 binders can trigger micronuclei formation in cancer cells at non-cytotoxic concentrations [1]. As micronuclei can play a crucial role in linking genome instability to innate immunity, we have here wondered whether G4 binders can induce immune gene activation in human MCF-7 breast cancer cells. By using RNA-Seq technology, we show that non-cytotoxic doses of PDS can activate Interferon beta- and IRF3-dependent genes leading to an innate immune gene response in human cancer cells. In addition, immune gene activation follows the induction of micronuclei formation supporting cytoplasmic DNA as a trigger of immune gene activation. Immunofluorescence assays showed that cGAS (a cytoplasmic DNA sensor) can bind to and is activated by micronuclei. In addition, cytostatic PDS concentrations activate STING and IRF3 factors leading to activated immune gene expression. STING inhibition with siRNAs, CRISPR knockout or a chemical inhibitor resulted in a suppression of immune gene expression and Interferon-beta (IFN-B) production in human MCF-7 and murine B16 cell lines, showing that STING is required for PDS-induced immune gene activation in cancer cells. We have then extended the study to a structurally-unrelated G4 binder, PhenDC3, and the results show that PhenDC3 can induce micronuclei formation and IFN-B production in a STING-dependent manner. Then, using TCGA-BRCA dataset, we show that specific gene expression patterns mediated by PDS correlate with immunological hot features of human tumors, such as anti-tumor immune cell infiltration. We could also define a specific PDS gene signature that can predict a better survival of breast cancer patients, suggesting an impact of immunomodulation potential of PDS or other G4 binders in human patients. Thus, our results provide strong evidence that G4 binders can activate innate immune genes in human and murine cancer cells with therapeutic potentials, and that G4 binder-induced micronuclei accumulation can trigger the cGAS-STING signaling pathway. The findings may open to the development of novel immunotherapeutic anticancer strategies based on G4-targeting compounds.

A new cytokine target for chronic obstructive pulmonary disease?

A new cytokine target for chronic obstructive pulmonary disease?