Cases Of Respiratory Disease Research Articles

Diversity of respiratory viruses present in nasal swabs under influenza suspicion in respiratory disease cases of weaned pigs

Respiratory diseases in weaned pigs are a common problem, with a complex etiology involving both viruses and bacteria. In the present study, we investigated the presence of eleven viruses in nasal swabs, collected from nurseries (55 cases) under the suspicion of swine influenza A virus (swIAV) and submitted by swine veterinarians for diagnosis. The other ten viruses included in the study were influenza B (IBV) and D (IDV), Porcine reproductive and respiratory syndrome virus (PRRSV), Porcine respiratory coronavirus (PRCV), Porcine cytomegalovirus (PCMV), Porcine circovirus 2 (PCV2), 3 (PCV3) and 4 (PCV), Porcine parainfluenza 1 (PPIV1) and Swine orthopneumovirus (SOV). Twenty-six swIAV-positive cases and twenty-nine cases of swIAV-negative respiratory disease were primarily established. While IBV, IDV, PCV4 and PPIV1 were not found in any of the cases, PRCV, SOV, and PCMV were more likely to be found in swIAV-positive nurseries with respiratory disease (p < 0.05). Overall, PCV3, PRRSV, and PCMV were the most frequently detected agents at herd level. Taken individually, virus prevalence was: swIAV, 48.6%; PRCV, 48.0%; PRRSV, 31.6%; SOV, 33.8%; PCMV, 48.3%, PCV2, 36.0%; and PCV3, 33.0%. Moreover, low Ct values (<30) were common for all agents, except PCV2 and PCV3. When the correlation between pathogens was individually examined, the presence of PRRSV was negatively correlated with swIAV and PRCV, while was positively associated to PCMV (p < 0.05). Also, PRCV and SOV were positively correlated between them and negatively with PCMV. Besides, the analysis of suckling pig samples, collected in subclinically infected farrowing units under an influenza monitoring program, showed that circulation of PRCV, PCMV, SOV, and PCV3 started during the early weeks of life. Interestingly, in those subclinically infected units, none of the pathogens was found to be correlated to any other. Overall, our data may contribute to a better understanding of the complex etiology and epidemiology of respiratory diseases in weaners. This is the first report of SOV in Spain and shows, for the first time, the dynamics of this pathogen in swine farms.

Effect of Nickel Mining on Acute Respiratory Infection Cases in Boenaga Village, Lasolo District, North Konawe Regency

Introduction: Nickel mining industry with air with nickel dust and combu stion gases. The main effects of dust on workers are either acute lung disorders or chronic physiological disorders, eye irritation, sensory irritation, and accumulation of harmful substances in the body. One of the negative impacts of nickel processing activities is environmental degradation which is characterized by air and many diseases related to the respiratory tract. This greatly affects the people who live close to mining areas, based on data from the Lasolo Island Health Center shows that ARI cases in 2020 were 126 cases, Asthma 85 cases, and Toddler Pneumonia 23 cases. The purpose of this study was to determine the effect of mining on cases of ARI in mining areas in the village of Boenaga.&#x0D; Method: The type of research used in this study is an observational study with a cross sectional analytic study.&#x0D; Result: The results showed that there was a relationship between dust exposure and cases of respiratory disease.&#x0D; Conclusion: The condition of indoor and outdoor air quality in exposed areas was higher than in non-exposed areas, but all of these are still below the permissible threshold value. The incidence of ARI in exposed locations increased significantly compared to non-exposed locations in Pomalaa district.

PSV-A-4 Novel Method to Identify Cattle Predisposed to Severe Cases of Bovine Respiratory Disease

Abstract Respiratory disease in several species can range from subclinical infection to acute death. Bovine respiratory disease (BRD) remains the greatest economic challenge facing the beef industry. Histones are core proteins in chromosomal structure that, when released extracellularly, are cytotoxic and could contribute to exacerbated tissue necrosis during infection. Work in our laboratory demonstrated cattle suffering severe cases of BRD had limited capacity to protect against the cytotoxic effects of extracellular histones, however, the protective mechanism(s) remain unknown. Literature suggests components of the complement system interact with extracellular histones, but the effects on cytotoxic activity of histones is unclear. The objective of the current experiment was to evaluate protective capacity against extracellular histones and complement activity in feedlot heifers and subsequent disease outcomes. Serum samples were collected from 118 heifer calves (BW 229 ± 2.4 kg) at feedlot arrival and evaluated for protective capacity against histone toxicity employing an extracellular histone toxicity assay; and complement activity using a 50% hemolytic complement screening assay. Animals were retrospectively assigned to groups consisting of: calves not requiring treatment with antibiotics for BRD (NT; n = 80) or calves that died from BRD within 1 wk of entering the feedlot (DA; n = 9). Serum from DA animals was less (P &amp;lt; 0.001) protective than NT animals against histone toxicity. Complement activity of DA animals was reduced (P &amp;lt; 0.05) compared to NT animals. Using a ratio of both assays under stringent selection points, the positive predictive value was 75%, and negative predictive value was 94%. Results indicate that cattle predisposed to severe cases of respiratory have impaired complement activity presumably contributing to impaired protective capacity against histone toxicity. Analyzing these functional pathways may provide a novel selection tool against cattle predisposed to severe cases of BRD.

Low Seroprevalence of SARS-CoV-2 among Healthcare Workers in Malaysia during the Third COVID-19 Wave: Prospective Study with Literature Survey on Infection Prevention and Control Measures

Healthcare workers (HCWs) are at greater risk for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. This serology surveillance study aimed to investigate the prevalence of SARS-CoV-2 antibodies among the HCWs who were asymptomatic during the third wave of COVID-19 in Malaysia. HCWs from the Universiti Sains Malaysia (USM) Health Campus were prospectively recruited between August 2020 and March 2021 on a voluntary basis. Data on socio-demographics, possible risk factors and travel history were recorded. Serological diagnoses from serum samples were examined for total antibodies against SARS-CoV-2 using an immunoassay kit. A literature survey was performed on the compliance with infection and prevention control (IPC) practices for COVID-19 among HCWs. The majority of the total 617 HCWs participating in this study were nurses (64.3%, n = 397), followed by health attendants (20.9%, n = 129), medical doctors (9.6%, n = 59) and others (6.3%, n = 39). Of those, 28.2% (n = 174) claimed to have exposure to COVID-19 cases, including history of close contact and casual contact with infected patients. Most importantly, all serum samples were found to be non-reactive to SARS-CoV-2, although nearly half (40.0%, n = 246) of the HCWs had been involved directly in the management of acute respiratory illness cases. A proportion of 12.7% (n = 78) of the HCWs reported having underlying health problems, such as diabetes mellitus, hypertension and hyperlipidemia. Despite the presence of medical and sociological risks associated with SARS-CoV-2 infections, the current study found zero prevalence of antibodies against SARS-CoV-2 among the HCWs of USM. Based on the literature survey, the vast majority of Malaysian HCWs demonstrated good IPC practices during the pandemic (average percentage ranged between 92.2% and 99.8%). High compliance with IPC measures may have led to the low seroprevalence of SARS-CoV-2 among the HCWs.

Detection of Chicken Respiratory Pathogens in Live Markets of Addis Ababa, Ethiopia, and Epidemiological Implications.

Simple SummaryIt is unclear what microorganisms are associated with respiratory disease in chickens sold in live markets of Addis Ababa, Ethiopia. Identifying microorganisms in diseased animals is the first step to delineating programs to control disease spread. Two Addis Ababa markets were visited weekly for three months to understand better the microorganisms found in chickens with respiratory disease. During this time, 18 sick chickens were acquired and tested for common microorganisms that cause respiratory disease in chickens. Three or more microorganisms, including viruses and bacteria, were detected in 17 of the 18 cases, showing that detection of multiple pathogens is widespread in live markets. These microorganisms possibly cause substantial productive loss in Ethiopia. Further studies are warranted to investigate their contribution to disease and economic losses in the country.A moderate to high seroprevalence of exposure to Newcastle disease (NDV), avian metapneumovirus (aMPV), infectious laryngotracheitis virus (ILTV), infectious bronchitis virus (IBV) and Mycoplasma gallisepticum (MG) has recently been reported in Ethiopia, but it is unclear to what extent these contribute to clinical cases of respiratory disease. This study investigated the presence of these pathogens in chickens exhibiting respiratory disease in two live markets in Addis Ababa. Markets were visited weekly for three months, and 18 chickens displaying respiratory clinical signs were acquired. Swab samples were taken from the choana, trachea, air sac and larynx for bacteriology and PCR tests targeting these five pathogens. PCR-positive samples were sequenced. All 18 chickens were PCR-positive for aMPV, 50% for each of Mg and NDV, 39% for IBV and 11% for ILTV. Infections with >3 pathogens were detected in 17 of 18 chickens. Potentially pathogenic bacteria such as Escherichia coli, Klebsiella spp., Streptococcus spp. and Staphylococcus were found in 16 to 44% of chickens. IBV-positive samples were of the 793B genotype. The results associate the presence of these organisms with clinical respiratory disease and are consistent with recent serological investigations, indicating a high level of exposure to multiple respiratory pathogens.

A retrospective analysis of respiratory virus transmission before and during the COVID-19 pandemic in Pune the western region of India.

BackgroundSARS-CoV-2 was first reported in China in December 2019 and quickly spread across the world. Non-pharmaceutical interventions (NPIs) are the key to control the transmission of respiratory viruses. To stop the spread, NPI is widely recommended and is still followed by most countries.MethodsAt the National Influenza Center of the Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), the surveillance of severe acute respiratory illness and acute respiratory illness cases for influenza and other respiratory viruses is in place. In this study, we analyzed surveillance data on respiratory viruses and/or SARS-CoV-2 testing from January 2017 to December 2021. Multiplex real-time PCR was used to detect the respiratory viruses.ResultsOur findings indicate that during the pandemic, the positivity for influenza A and B, metapneumovirus, parainfluenza virus, respiratory syncytial virus, and human coronavirus declined significantly.ConclusionThe annual distinct seasonal outbreaks of influenza, RSV, and other respiratory viruses as observed during the pre-COVID-19 period were not observed during the COVID-19 pandemic in years 2020 and 21. Social distancing, lock-downs, and non-pharmaceutical interventions may play an important role in the reduction of respiratory viruses. Understanding the seasonal respiratory virus decline could help public health experts prepare for future respiratory virus pandemics.

A high‐speed unsupervised hardware architecture for rapid diagnosis of COVID‐19

SummaryIn the diagnosis of COVID‐19, investigation, analysis, and automatic counting of blood cell clusters are the most essential steps. Currently employed methods for cell segmentation, identification, and counting are time‐consuming and sometimes performed manually from sampled blood smears, which is hard and needs the support of an expert laboratory technician. The conventional method for the blood‐count‐test is by automatic hematology analyzer which is quite expensive and slow. Moreover, most of the unsupervised learning techniques currently available presume the medical practitioner to have a prior knowledge regarding the number and action of possible segments within the image before applying recognition. This assumption fails most often as the severity of the disease gets increased like the advanced stages of COVID‐19, lung cancer etc. In this manuscript, a simplified automatic histopathological image analysis technique and its hardware architecture suited for blind segmentation, cell counting, and retrieving the cell parameters like radii, area, and perimeter has been identified not only to speed up but also to ease the process of diagnosis as well as prognosis of COVID‐19. This is achieved by combining three algorithms: the K‐means algorithm, a novel statistical analysis technique‐HIST (histogram separation technique), and an islanding method an improved version of CCA algorithm/blob detection technique. The proposed method is applied to 15 chronic respiratory disease cases of COVID‐19 taken from high profile hospital databases. The output in terms of quantitative parameters like PSNR, SSIM, and qualitative analysis clearly reveals the usefulness of this technique in quick cytological evaluation. The proposed high‐speed and low‐cost architecture gives promising results in terms of performance of 190 MHz clock frequency, which is two times faster than its software implementation.

Neurological Manifestations of COVID-19

Coronavirus disease 2019 (COVID-19) is defined as illness caused by a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-nCoV), which was first identified amid an outbreak of respiratory illness cases in Wuhan City, Hubei Province, China [1]. It was initially reported to the WHO on December 31, 2019. On January 30, 2020, the WHO declared the COVID-19 outbreak a global health emergency [2, 3]. On March 11, 2020, the WHO declared COVID-19 a global pandemic, its first such designation since declaring H1N1 influenza a pandemic in 2009 [4]. Keywords: COVID-19, Neurological manifestations

Environmental Crises and Impacts of Climate Change on Health

Already, the rising temperatures are indeed being seen, and the outlook for the future is gloomy as a result. Global warming is no longer a topic of debate merely a potential danger. The WHO projects that there will be additional 250000 excess deaths each year between the years 2030-2050 as a direct result of the effects that are currently understood. Regarding the changing climate. Morbidity and mortality associated with heat, as well as increases in vector-borne diseases, are some of the effects (e.g. Dengue fever, malaria) higher cases of respiratory disease as well as mortality death toll attributed to harsh weather conditions. Changes in the climate that are incremental, including rising temperatures and sea level, and sporadic drought all have the potential to alter natural environments and cause widespread disruption. including climate warming and sea level, Change land use, agricultural conditions, deteriorate infrastructure and cause financial and interpersonal strain, and increase the likelihood of a variety of adverse health effects. Hostility, violence, and the uprooting of entire villages are all examples. Bringing about a shift in climate relevant at the local level by establishing connections to prominent local concerns and benefits. Comprises a crucial move toward closing the gap between increased worldwide awareness and the increasing importance of the topic locally, and especially for populations that are vulnerable. If we are to avoid the dangers that come with climate change: We need to change, and change drastically, in the ways that we think about things, the ways that we behave, and the ways that we allocate and deploy our resources, whether they be economic, human, or institutional. The essential part civil redesign is one of the greatest issues of our day; the environmental catastrophe, as a result, has an Anthropological dimension. This indicates that we will be required to re-examine both our cultural and types of social organization that are moving away from a culture that is center on consumerism and possessions. The environmental imperative requires us to rethink what it means to be an individual and what it means to be a community. According to the Global Environmental Outlook, even though humans have always had an impact on their environment, local environment, the ever-evolving character of human society, and the magnitude of the impact that these factors have on ecological systems have created a burden that is too great for the atmosphere, land, and water of the planet to bear.

Pathobiology of an NS1-Truncated H3N2 Swine Influenza Virus Strain in Pigs.

ABSTRACTVirus strains in the live attenuated influenza vaccine (LAIV) for swine in the United States that was on the market until 2020 encode a truncated nonstructural protein 1 of 126 amino acids (NS1del126). Their attenuation is believed to be due to an impaired ability to counteract the type I interferon (IFN)-mediated antiviral host response. However, this mechanism has been documented only in vitro for H3N2 strain A/swine/Texas/4199-2/98 NS1del126 (lvTX98), and several cases of clinical respiratory disease in the field were associated with the LAIV strains. We therefore further examined the pathobiology, including type I IFN induction, of lvTX98 in pigs and compared it with IFN induction in pig kidney-15 (PK-15) cells. lvTX98 induced up to 3-fold-higher type I IFN titers than wild-type TX98 (wtTX98) after inoculation of PK-15 cells at a high multiplicity of infection, while virus replication kinetics were similar. Mean nasal lvTX98 excretion by intranasally inoculated pigs was on average 50 times lower than that for wtTX98 but still reached titers of up to 4.3 log10 50% tissue culture infective doses/mL. After intratracheal inoculation, mean lvTX98 titers in the lower respiratory tract were significantly reduced at 18 to 48 h postinoculation (hpi) but similar to wtTX98 titers at 72 hpi. lvTX98 caused milder clinical signs than wtTX98 but induced comparable levels of microscopic and macroscopic lung lesions, peak neutrophil infiltration, and peak type I IFN. Thus, lvTX98 was partly attenuated in pigs, but this could not be associated with higher type I IFN levels.IMPORTANCE Swine influenza A viruses (swIAVs) with a truncated NS1del126 protein were strongly attenuated in previous laboratory-based safety studies and therefore approved for use as LAIVs for swine in the United States. In the field, however, the LAIV strains were detected in diagnostic samples and could regain a wild-type NS1 via reassortment with endemic swIAVs. This suggests a significant degree of LAIV replication and urges further investigation of the level and mechanism of attenuation of these LAIV strains in vivo. Here, we show that H3N2 LAIV strain lvTX98 is only partly attenuated in pigs and is excreted at significant titers after intranasal vaccination. Attenuation and restricted replication of lvTX98 in vivo seemed to be associated with the loss of NS1 functions other than type I IFN antagonism. Our findings can help to explain the occurrence of clinical respiratory disease and reassortment events associated with NS1del126-based LAIV strains in the field.

Analysis of specific sIgE detection of house dust mites and aspergillus fumigatus in 2 535 patients with respiratory allergic diseases and respiratory infectious diseases in the Guangzhou area

Objective: To compare the specific IgE positive rates of the patients between allergic respiratory diseases and respiratory infectious diseases in Guangzhou, the relationship between the co-sensitization of house dust mite (HDM) allergen and Aspergillus fumigatus (AF) allergen and asthma, allergic rhinitis with asthma, pneumonia, upper respiratory infections, bronchitis, serum total immunoglobulin E (total Immunoglobulin E, tIgE) and age were analyzed, to provide the basis for the prevention and treatment of respiratory allergic diseases and respiratory infectious diseases in this area. Methods: A total of 2 535 patients with confirmed respiratory allergic diseases and respiratory infectious diseases were selected retrospectively from the outpatient or inpatient department of the First Affiliated Hospital of Guangzhou Medical University from April 2017 to June 2021 and detected HDM and AF specific IgE (sIgE) by the ImmunoCAP system. The age range was 1 to 89 years. The median age was 5 years. The average age was 9. ≤3 years old group n=894, 4-6 years old group n=721, 7-18 years old group n=615, 19-49 years old group n=207, >49 years old group n=98. There were 1 596 males (62.96%) and 939 females (37.04%). There were 1 279 cases of allergic diseases and 1 256 cases of respiratory infectious diseases. The different disease groups were divided into asthma group (411 cases), allergic rhinitis group (458 cases), allergic rhinitis combined with asthma group (410 cases), pneumonia group (463 cases), upper respiratory tract infection group (299 cases) and bronchitis group (494 cases). The difference of specific IgE (sIgE) and tIgE between HDM and AF was analyzed. For statistical analysis, continuous variables were tested by Mann-Whitney U. Classification data by chi-square test or Fisher's exact test. Results: 1 313 (51.79%) patients were sIgE positive for HDM allergen, 65 (2.56%) were sIgE positive for AF allergen, and 50 (1.97%) were both positive. In the respiratory allergic disease group, 877 cases (68.57%,877/1 279) were positive for HDM allergen sIgE, 57 cases (4.46%,57/1 279) were positive for AF allergen sIgE, and 44 cases (3.44%,44/1 279) were both positive; 436 cases (34.71%,436/1 256) of respiratory infectious diseases were positive for HDM allergen sIgE, 8 cases (0.64%,8/1 256) were positive for AF allergen sIgE, and 6 cases (0.48%,6/1 256) were both positive. In monosensitization, the HDM allergen sIgE sensitization rate was the highest in the allergic rhinitis & asthma group, at 80.24% (329/410). The positive rate of HDM allergen sIgE in male patients was 53.76%(858/1 596), and the positive rate in female patients was 46.22%(434/939), and the difference between the two was statistically significant (χ2=13.449, P<0.001). In polysensitization, asthma patients (5.35%,22/411) had the highest positive rate of HDM sensitization with AF, followed by allergic rhinitis patients (3.06%,14/458), allergic rhinitis with asthma (1.95%,8/410). The positive rate of respiratory infectious diseases such as pneumonia (0.43%,2/463), upper respiratory infections (0.33%,1/299), and bronchitis (0.61%,3/494) with AF was extremely low. The positive rate of HDM combined with AF in infants(≤3 years old group,0.34%, 3/894; 4-6 years old group, 0.97%, 7/721)was significantly lower than that in teenagers and adults(7-18 years old group,3.58%, 22/615; 19-49 years old group,6.28%, 13/207;>49 years old group,5.10%, 5/98).In the patients with HDM and AF combined sensitization, HDM sIgE levels were distributed in all grades, and AF sIgE levels were mainly in grades 1, 2, and 3. Conclusion: The positive rate of HDM combined with AF was higher in patients with respiratory allergic diseases such as asthma, allergic rhinitis, and allergic rhinitis combined with asthma, suggesting that clinical attention should be paid to the combination of HDM and AF in patients with asthma and allergic rhinitis, especially adults, more likely to be combined with AF.

Dr Li Wenliang: Wuhan “Whistleblower” and Early COVID-19 Victim

Dr Li Wenliang: Wuhan “Whistleblower” and Early COVID-19 Victim

Impact of Particulate Matter on Hospitalizations for Respiratory Diseases and Related Economic Losses in Wuhan, China.

BackgroundPrior studies have reported the effects of particulate matter (PM) on respiratory disease (RD) hospitalizations, but few have quantified PM-related economic loss in the central region of China. This investigation aimed to assess the impacts of PM pollution on the risk burden and economic loss of patients admitted with RD.MethodsDaily cases of RD admitted to the hospital from 1 January 2015 to 31 December 2020 were collected from two class-A tertiary hospitals in Wuhan, China. Time series analysis incorporated with a generalized additive model (GAM) was adopted to assess the impacts of fine particulate matter (PM2.5) and inhalable particulate matter (PM10) exposures on patients hospitalized with RD. Stratified analyses were performed to investigate underlying effect modification of RD risk by sex, age, and season. The cost of illness (COI) approach was applied to evaluate the related economic losses caused by PM.ResultsA total of 51,676 inpatients with a primary diagnosis of RD were included for the analysis. PM2.5 and PM10 exposures were associated with increased risks of hospitalizations for RD. Subgroup analysis demonstrated that men and children in the 0–14 years age group were more vulnerable to PM, and the adverse effects were promoted by low temperature in the cold season. A 152.4 million China Yuan (CNY) economic loss could be avoided if concentrations of PM2.5 and PM10 declined to 10 and 20 μg/m3, respectively.ConclusionsPM2.5 and PM10 concentrations were positively associated with RD hospitalization. Men and children were more vulnerable to PM. Effective air pollution control measures can reduce hospitalizations significantly and save economic loss substantially.

Occupational asthma in office workers.

Office work has a relative perception of safety for the worker. Data from surveillance schemes and population-based epidemiological studies suggest that office work carries a low risk of occupational asthma (OA). Office workers are frequently used as comparators in studies of occupational exposure and respiratory disease. We aimed to describe and illustrate our tertiary clinical experience of diagnosing OA in office workers. We searched the Birmingham NHS Occupational Lung Disease Service clinical database for cases of occupational respiratory disease diagnosed between 2002 and 2020, caused by office work or in office workers. For patients with OA, we gathered existing data on demographics, diagnostic tests including Occupational Asthma SYStem (OASYS) analysis of serial peak expiratory flow and specific inhalational challenge, and employment outcome. We summarised data and displayed them alongside illustrative cases. There were 47 cases of OA (5% of all asthma) confirmed using OASYS analysis of PEFs in the majority. Sixty percent of cases occurred in healthcare, education and government sectors. The most frequently implicated causative exposures or agents were: indoor air (9), printing, copying and laminating (7), cleaning chemicals (4), mould and damp (4), and acrylic flooring and adhesives (4). Exposures were grouped into internal office environment, office ventilation-related and adjacent environment. Clinicians should be vigilant for exposures associated with OA in office workers who present with work-related symptoms, where respiratory sensitizing agents may be present. A structured approach to assessment of the workplace is recommended.

Clinical features of COVID-19 for integration of COVID-19 into influenza surveillance: A systematic review.

BackgroundIn November 2020, the World Health Organization (WHO) created interim guidance on how to integrate testing for SARS-CoV-2 into existing influenza surveillance systems. Influenza-like illness (ILI) and severe acute respiratory illness (SARI) case definitions have been used to specify the case definition of COVID-19 for surveillance purposes. This review aims to assess whether the common clinical features of COVID-19 have changed to the point that the criteria used to identify both COVID-19 and influenza in surveillance programs needs to be altered.MethodsA systematic review of reviews following PRISMA-P guidelines was conducted using the “COVID-19 evidence review” database from August 19, 2020, to August 19, 2021. Reviews providing pooled estimates of the prevalence of clinical features of COVID-19 within the general population, diagnosed by polymerase chain reaction or rapid diagnostic test, were included. These were critically appraised and sensitivity analysis was undertaken to examine potential causes of bias.ResultsFourteen reviews were identified, including three on adults only and three on children only. For all reviews, combined fever (median prevalence = 73.0%, IQR = 58.3-78.7) and cough (45.1%, IQR = 28.9-54.0) were the most common features. These were followed by loss of taste or smell (45.1%, IQR = 28.9-54.0), hypoxemia (33%, one review), fatigue (26.4%, IQR = 9.0-39.4) and expectoration (23.9%, IQR = 23.3-25.5). Fever and cough continued to be the most prevalent features for adults and children, with subsequent symptoms being similar for adults only. However, the pattern differed for children, with headache (34.3%, IQR = 18-50.7) and nasal congestion (20%, one review) being the third and fourth commonest symptoms.ConclusionsThe prevalent features found in this recent review were the same as the ones identified at the beginning of the pandemic. Therefore, the current approach of using the ILI and SARI criteria which incorporate fever and cough will identify COVID-19 cases in addition to influenza. Interestingly, children may present with different features, as headaches and nasal congestion were more common in this group. Future research could examine this further and investigate whether symptomology changes with new variants of COVID-19.

In vitro antiviral activity of Thymbra spicata L. extract on bovine respiratory viruses (BCoV, BPIV-3, BRSV, BVDV and BoHV-1)

Viral pathogens are the primary agents in bovine respiratory disease cases, and there is no direct effective antiviral drug application. Thymbra is a genus of oregano commonly found in Turkey. The primary component (34.9%) of the extract obtained from Thymbra spicata L. is the carvacrol which is used in traditional medicine. This study evaluates the potential antiviral activity and inactivation efficiency of T. spicata L. extract against bovine respiratory viruses, including BCoV, BPIV-3, BRSV, BVDV and BoHV-1. To evaluate its effect on viral replication, viral titres were taken from infected cells treated with non-cytotoxic T. spicata L. extract concentrations (0.75% and 1.5%, 1.32 and 2.64µg/ml of carvacrol as active ingredient, respectively) and compared to non-treated infected cells. The viruses were treated directly with 1.5% T. spicata L. extract, and the viral titres were evaluated at certain time points to determine the efficiency of direct inactivation. The number of infectious virions for BCoV, BPIV-3, BRSV, BVDV and BoHV-1 treated with 1.5% T. spicata L. extract were decreased by 99.44%, 100.0%, 94.38%, 99.97% and 99.87%, respectively.T. spicata L. extract strongly inhibits the replication of mentioned viruses in a dose-dependent manner in vitro. In addition, T. spicata L. extract shared direct inactivation efficiency on the mentioned viruses in a time-dependent manner. This study shows the antiviral efficiency of T. spicata L. on BRD-related viral agents for the first time. The oregano species T. spicata and its main component, carvacrol, may have a potential for antiviral activity in the alternative treatment of respiratory viral diseases in cattle. Given the similarity of replication strategies, obtained data suggest the possible efficiency of T. spicata L. on human respiratory viruses.

The National Occupational Respiratory Disease Registry (NORDR): it is time to learn from failure.

The National Occupational Respiratory Disease Registry (NORDR): it is time to learn from failure.

Clinical and Economic Impact of COVID-19 in Vascular Surgery at a Tertiary University “Hub” Hospital of Italy

BackgroundSince the first cases of a novel respiratory disease were reported in December 2019, coronavirus disease (COVID-19) Emergency State (Cov-ES) caused a worldwide outbreak requiring a complete reorganization of the healthcare system and new management of its personnel; aim of this study was to analyze the clinical and financial impact of Cov-ES in the Department of Vascular Surgery at a Tertiary University “Hub” Hospital in northeast Italy.MethodsDifferences in clinical practice according to Diagnostic Related Group (DRG) and International Statistical Classification of Diseases (ICD) and Related Health Problems and the financial impact of Cov-ES were considered. Vascular procedures performed between March 2019 and December 2019 (Prepandemic) were compared to those performed in the period March–December 2020 (Pandemic). Prepandemic and pandemic reimbursements of all vascular activities and the top 3 vascular diagnoses were evaluated.ResultsPrepandemic versus pandemic era documented a decrease of vascular consultations performed (2,882 vs. 2,270, −21.2%). The number of total vascular procedures decreased from 997 to 797 (−20.1%) with a higher reduction observed in outpatient surgical activities (247 to 136, −45.0%, P = 0.0005) rather than inpatient surgical activities (750 vs. 661, 11.9%, P = 0.02). Length of hospital stay (LOS) increased from 3.3 ± 2.7 days in prepandemic to 5.3 ± 3.9 in the pandemic era (P = 0.004). Among patients with limb-threatening ischemia, the rate of major limb amputation was higher in the pandemic (3.3% vs. 5.4%, respectively, P = 0.02), and a higher rate of elective hospitalization procedures was performed as urgent/emerging setting after clinical deterioration (2.8 % vs. 6.4%, P = 0.0002). According to DRG classification, an increase of “complicated” limb-threatening ischemia (DRG 554) and aortic aneurysm (DRG 110) was observed prepandemic to pandemic (+84.2% and +25.0%, respectively). Total reimbursement for vascular activities between pandemic versus prepandemic was 4,646,108€ vs. 5,054,398€, respectively (−8.0%). Management of “complicated” limb-threatening ischemia (DRG 554) and aortic aneurysm (DRG 110) required a higher clinical and financial support that was translated into higher economic reimbursement during the pandemic (273,035€ vs. 150,005€, +82.0% and 749,250€ vs. 603,680€, +24.1%, respectively).ConclusionsDuring the pandemic, the main resources were employed for the treatment of limb-threatening ischemia, aortic aneurysm, and carotid stenosis. Inpatient activities documented an increase in major limb amputation and LOS. An increased reimbursement for each vascular procedure and for all “complicated” diagnoses revealed that the more serious and resource-demanding pathology occurred in this period.

Evaluation of Monitored Anesthesia Care Involving Sedation and Axillary Nerve Block for Day-Case Hand Surgery.

Background: Ultrasound-guided axillary brachial plexus block (ABPB) is a technique of choice for regional anesthesia during hand and forearm surgery. Intravenous sedation may facilitate this procedure, particularly for those suffering from anxiety; however, it can also be associated with respiratory, cardiovascular, and neurological side effects. The objective of this study was to evaluate the effect of intravenous sedation on perioperative respiratory depression for patients undergoing day-case hand surgery under ABPB. Methods: A prospective, observational, single-center study was conducted between 1 May and 1 November 2016. Results: A total of 2318 patients were included, with 501 patients in the group with IV sedation and 1817 in the group without. A multivariable propensity-score matched analysis showed that the variables associated with the number of desaturation were: (i) sedation (aRR 1.534 [95% CI: 1.283 to 1.836]), (ii) age and sex, (iii) type of surgery, and iv) Body Mass Index (BMI). Conclusions: Supplementing ABPB with IV sedation was associated with an increased rate of respiratory depression (episodes of desaturation) compared to fully awakened patients. The rate of oxygen administration was also higher in sedated patients even though they had fewer cases of chronic respiratory diseases and fewer were active smokers than non-sedated patients. Future research should consider precisely evaluating patient satisfaction, as well as the differences between sedation and drug-free approaches.

Desaturation during the pandemic: Covid or cognitive bias?

The coronavirus pandemic has put an unprecedented strain on our health care system. An urgent need for timely and accurate diagnosis coupled with an inordinate caseload and myriad overlapping signs and symptoms with other differentials is leaving physicians fatigued. This often leads to the use of mental shortcuts - "heuristics" by the strained mind and the inadvertent use of intuitive thought processes rather than the more controlled analytical thinking to cope and speed up the decision-making process. Availability bias - making a recent or vivid patient diagnosis more readily accessible to the mind - and anchoring bias - relying too heavily on a single symptom for deducing diagnosis - are among the most prevalent cognitive biases. Therefore, it is not unexpected that any new cases of acute onset respiratory illness may be mis-diagnosed as coronavirus disease 2019 during the pandemic, significantly impacting the morbidity and mortality of true diagnosis. To reduce the risk of patient harm, it is therefore imperative that medical practitioners be aware of the existence and influence of cognitive bias in clinical decision making and maintain sight of a variety of differential diagnoses to ensure that no adverse condition is overlooked.