Prevent Disease Transmission Research Articles

COVID-19 Pandemic and Anesthetic Challenges in Indian Scenario

Due to the widespread nature of the COVID-19 pandemic, the safety of anesthesiologists is an international concern. Many international societies have issued consensus statements or guidelines for the anesthesiologists during the COVID-19 pandemic.[1] [2] These guidelines should be adopted strictly to prevent disease transmission. As the pandemic progresses, patients ranging from asymptomatic carriers to those who present with a false negative COVID-19 test may approach the anesthesiologist. Thereby, in this situation, the need arises for proper precaution for all aerosol-generating medical procedures, and anesthesiologist should renew their familiarity with airborne isolation procedures, which are seldom necessary in routine anesthesia practice. However, to follow all the steps of these guidelines properly is challenging in the Indian scenario. Local modification for safety of healthcare workers is the need of the hour.

Recommendations for Dental Care during COVID-19 Pandemic.

Dental clinics were suspected to be a hotspot for nosocomial transmission of coronavirus disease 19 (COVID-19), yet there has been no clear recommendation about emergency dental care and appropriate personal protective equipment during pandemics. In this paper, we aim to summarize recommendations for (i) patient risk assessment, (ii) patient triage, and (iii) measures to prevent infection of health professionals and nosocomial transmission in dental clinics. The available evidence was collected by performing searches on PubMed, Embase, and Cochrane databases. We reviewed papers on COVID-19, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, and related respiratory viral diseases. Legal and ethical frameworks, as well as international (e.g., World Health Organization (WHO)) and national (e.g., public health institutes, dental associations) guidelines were screened to summarize recommendations related to dental emergency care. To assess the patient risk, a questionnaire was developed to classify patients at unknown, high, and very high risk. Patient triage recommendations were summarized in a flow chart that graded the emergency level of treatments (i.e., urgent, as soon as possible, and postpone). Measures to prevent disease transmission based on current evidence were grouped for dental health professionals, dental clinics, and patients. The present recommendations may support health professionals implement preventative measures during the pandemic.

Recommendations for surgical management of recurrent nasopharyngeal carcinoma during COVID-19 pandemic.

Nasopharyngeal carcinoma is endemic in southern parts of China including Hong Kong. Primary treatment entails radiotherapy ± chemotherapy depending on disease stage at presentation. Surgery is offered as a means of salvage for persistent and recurrent disease. Comprehensive preoperative work‐up, careful patient selection, attention to details perioperation and multidisciplinary approach is essential in ensuring optimal outcomes after salvage surgery for recurrent nasopharyngeal carcinoma patients. Since the COVID‐19 outbreak, we are faced with unprecedented challenges with priorities of care and resources being shifted to combat the virus. These include patient selection and timing of treatment, while preventing disease transmission to heath care providers. Practices and recommendations made in this document are intended to support safe clinical practice and efficient use of resources during this challenging time.

Strategies for Preventing Disease Transmission at Early Childhood Education Institutions

Early childhood education institutions with a lack of health standards can be a medium for disease transmission. This transmission leads to a decline in health status and the level of children's development. Preschool children often suffer from several infectious diseases such as chickenpox, diphtheria, measles, mumps, hepatitis B, influenza, pulmonary tuberculosis, impetigo, and diarrhea. These diseases can be transmitted through direct or indirect contact such as respiratory tract, digestion, and skin. Disease transmission can occur during interactions between children and children, children and teachers, and children and the environment around the school. The risk of disease transmission can be reduced by implementing prevention strategies for disease transmission, that is, by creating a healthy environment of the educational institution, keeping hands clean, providing handwashing facilities, implementing cough ethics, and increasing the role of teachers and parents to establish children's clean and healthy living behavior. These strategies can work well if they are supported and carried out by the manager, teachers, children, educational personnel, and parents. The strategies are expected to improve the health status of children, so they can achieve growth and development by their stages.

MON-035 Does Androgen Exposure Result in Germline Transmission of PCOS-Like Phenotypes and Can It Be Reversed?

Daughters of women with polycystic ovary syndrome (PCOS) are more likely to be diagnosed with PCOS, including reproductive and metabolic dysfunctions. Our recent research has demonstrated that dihydrotestosterone (DHT) exposure during late pregnancy results in transgenerational transmission of PCOS susceptibility to female offspring. But it remains unclear whether the transmission of the PCOS-like phenotypes is induced by in utero environment or via germ cell reprogramming, and whether treatment by exercise or androgen receptor blocker, flutamide, can prevent disease transmission. To model PCOS condition, donor mice were implanted with a continuous releasing DHT or vehicle pellet at 4 weeks of age. A subset of DHT exposed F0 donors had either free access to running wheels or were implanted with a slow-releasing flutamide pellet. Mice were exposed with or without treatment for either 6 weeks before IVF or 10 weeks prior to phenotypic testing. Here we present the phenotype of the F0 donors and the result of IVF to generate first (F1) and second (F2) generation offspring. Donors weigh more already after 2 weeks of DHT exposure and had more fat mass with larger adipocyte size, impaired glucose tolerance, and heavier kidney after 10 weeks of androgenization, which was reversed by both flutamide and exercise intervention. Moreover, DHT exposure increased circulating androgens and donors were completely acyclic. Simultaneous treatment with flutamide reversed the elevated androstenedione, testosterone, and restored estrus cyclicity, indicating that androgen receptor blocker can reverse hyperandrogenemia and reproductive dysfunction, whereas exercise failed to improve these phenotypes. After 6 weeks of exposure or treatment, donor oocytes were superovulated for IVF. Fewer oocytes per donor were found in androgenized + flutamide lineage, but no significant difference was observed in oocyte to two-cell embryo conversion rate after fertilization among all groups. Although the number of live offspring at weaning was similar among all groups, a trend of more F1 male than female offspring was found in both androgenized and androgenized + exercise lineage. Similar results were obtained in the F1 females when generating F2 offspring by IVF, which androgenized + flutamide lineage showed fewer oocytes per donor upon superovulation and more F2 male than female offspring was obtained in androgenized lineage at weaning. We here show that the androgenized donors develop clear PCOS-like phenotypes and give rise to more male than female F1 and F2 offspring. While blocking androgen receptor reverses both metabolic and reproductive disturbance in the donor, it also shows a negative impact on the donor and F1 female oocyte maturation process, although number of offspring via IVF is not affected. Excercise, however, only reverses the metabolic phenotypes in the F0 donor mice with no impact on IVF outcome.

Clinical characteristics of asymptomatic and symptomatic patients with mild COVID-19

ObjectivesDetailed knowledge on the prevalence of asymptomatic cases of coronavirus disease 2019 (COVID-19) and the clinical characteristics of mild COVID-19 is essential for effective control of the COVID-19 pandemic. We determined the prevalence of asymptomatic cases of COVID-19 and characterized the symptoms of patients with mild COVID-19. MethodsStudy participants were recruited from a community facility designated for the isolation of patients without moderate-to-severe symptoms of COVID-19 in South Korea. The prevalence of asymptomatic patients at admission and the detailed symptoms of mild COVID-19 were evaluated through a questionnaire-based survey. Diagnosis of COVID-19 was confirmed by real-time RT-PCR. ResultsOf the 213 individuals with COVID-19, 41 (19.2%) were asymptomatic until admission. Among the remaining patients with mild COVID-19, the most common symptom was cough (40.1%; 69/172), followed by hyposmia (39.5%; 68/172) and sputum (39.5%; 68/172). Of the 68 individuals with hyposmia, 61 (90%) had accompanying symptoms such as hypogeusia, nasal congestion or rhinorrhoea. Fever (>37.5°C) was only observed in 20 (11.6%) individuals. ConclusionsAs much as one-fifth of individuals with COVID-19 remained asymptomatic from exposure to admission. Hyposmia was quite frequent among individuals with mild COVID-19, but fever was not. Social distancing should be strongly implemented to prevent disease transmission from asymptomatic individuals or those with mild and inconspicuous symptoms.

Implementation Guide for Rapid Integration of an Outpatient Telemedicine Program During the COVID-19 Pandemic

BackgroundIn the novel coronavirus disease 2019 (COVID-19) pandemic, social distancing has been necessary to help prevent disease transmission. As a result, medical practices have limited access to in-person visits. This poses a challenge to maintain appropriate patient care while preventing a substantial backlog of patients once stay-at-home restrictions are lifted. In practices that are naïve to telehealth as an alternative option, providers and staff are experiencing challenges with telemedicine implementation. We aim to provide a comprehensive guide on how to rapidly integrate telemedicine into practice during a pandemic.MethodsWe built a toolkit that details the following 8 essential components to successful implementation of a telemedicine platform: provider and staff training, patient education, an existing electronic medical record system, patient and provider investment in hardware, billing and coding integration, information technology support, audiovisual platforms, and patient and caregiver participation.ResultsRapid integration of telemedicine in our practice was required to be compliant with our institution’s COVID-19 task force. Within 3 days of this declaration, our large specialty-care clinic converted to a telemedicine platform and we completed 638 visits within the first month of implementation.ConclusionsEffective and efficient integration of a telemedicine program requires extensive staff and patient education, accessory platforms to facilitate video and audio communication, and adoption of new billing codes that are outlined in this toolkit.

Gambaran Radiografi Tuberkulosis Paru Multidrug-Resistant: Studi Retrospektif di Rumah Sakit Umum Dr. Soetomo Surabaya

Background: Multidrug-resistant pulmonary tuberculosis (MDR-TB) is a major health problem worldwide. Prompt diagnosis is necessary for insuring appropriate therapy to lower morbidity and mortality, as well as to prevent disease transmission. Determination of drug-resistance patterns through microbiological examination is sometimes challenging, especially when the sputum acid-fast bacilli smear is negative. Therefore, it is worthwhile to investigate whether there may be radiographic patterns suggesting MDR-TB infection. The objective of this study was to evaluate the radiographic features of MDR-TB. Methods: From September 2015 to March 2018, 167 patients with microbiologically proven MDR-TB were enrolled in the study. All radiographs were obtained before the patients received MDR-TB chemotherapy regimen. Posterior-anterior chest radiography was performed using digital radiography system (Hitachi Radnext50 500mAs) and retrospectively reviewed as digital raw data. Results: Based on severity category, 60% had severe lesion, 31% had moderate lesion, and only 9% had mild lesion. The most frequently observed findings were ground glass opacity or consolidation, noted in 96% patients, with bilateral lung involvement in 81% patients; fibrosis (95%), cavity (78%; 87% of which were multiple), interstitial opacities (53%), pleural thickening and mediastinal shift (59%). Other radiological findings were calcification (16%), emphysema (13%), lung destruction (12%), atelectasis (10%), nodule (8%), bullae (8%), bronchiectasis (5%), miliary pattern (1%), pleural effusion (25%), pneumothorax (1%), and hilar lymphadenopathy (14%) which predominantly unilateral. Conclusion: The presence of severe pulmonary lesion, ground glass opacity or consolidation with bilateral lung involvement, fibrosis, multiple cavities, interstitial opacities, pleural thickening, and mediastinal shift are the main features of MDR-TB.

Experimental Evidence Reveals Both Cross-Infection and Cross-Contamination Risk of Embryo Storage in Liquid Nitrogen Biobanks.

Simple SummaryThis study was conducted to demonstrate the potential hazards of cross-infection and cross-contamination of embryos during storage in liquid nitrogen biobanks. For the harmless and successful cryopreservation of embryos, the vitrification method must be chosen meticulously to guarantee not only a high post-thaw survival of embryos, but also to reduce the risk of disease transmission when those embryos are in storage for long periods.In recent decades, gamete and embryo cryopreservation have become routine procedures in livestock and human assisted reproduction. However, the safe storage of germplasm and the prevention of disease transmission continue to be potential hazards of disease transmission through embryo transfer. This study aimed to demonstrate the potential risk of cross-infection of embryos from contaminated liquid nitrogen, and cross-contamination of sterile liquid nitrogen from infected embryos in naked and closed devices. Additionally, we examined the effects of antibiotic-free media on culture development of infected embryos. The study was a laboratory-based analysis using rabbit as a model. Two experiments were performed to evaluate both cross-infection (liquid nitrogen to embryos) and cross-contamination (embryos to liquid nitrogen) of artificially inoculated Salmonella Typhimurium, Staphylococcus aureus, Enterobacter aerogenes, and Aspergillus brasiliensis. Rapid cooling through vitrification was conducted on rabbit embryos, stored for a year, thawed, and cultured. In vivo produced late morulae–early blastocyst stages (72 h) embryos were used (n = 480). Embryos were cultured for 1 h in solutions with and without pathogens. Then, the embryos were vitrified and stored in naked and closed devices for one year in two liquid nitrogen biobanks (one pathogen-free and the other artificially contaminated). Embryos were warmed and cultured for a further 48 h, assessing the development and the presence of microorganism (chromogenic media, scanning electron microscopy). Embryos stored in naked devices in artificially contaminated liquid nitrogen became infected (12.5%), while none of the embryos stored in closed devices were infected. Meanwhile, storage of artificially infected embryos incurred liquid nitrogen biobank contamination (100%). Observations by scanning electron microscopy revealed that all the microorganisms were caught in the surface of embryos after the vitrification-thawed procedure. Nevertheless, embryos cultured in antibiotics and antimycotic medium developed to the hatched blastocyst stage, while artificially infected embryos cultured in antibiotic-free medium failed to develop. In conclusion, our findings support that both cross-contamination and cross-infection during embryo storage in liquid nitrogen biobanks are plausible. So, to ensure biosafety for the cryogenic storage, closed systems that avoid direct contact with liquid nitrogen must be used. Moreover, it seems essential to provide best practice guidelines for the cryogenic preservation and storage of gametes and embryos, to define appropriate quality and risk management procedures.

Visiting Policies of Hospice Wards during the COVID-19 Pandemic: An Environmental Scan in Taiwan

During an epidemic, almost all healthcare facilities restrict the visiting of patients to prevent disease transmission. For hospices with terminally ill patients, the trade-off between compassion and infection control becomes a difficult decision. This study aimed to survey the changes in visiting policy for all 76 hospice wards in Taiwan during the COVID-19 pandemic in March 2020. The altered visiting policies were assessed by the number of visitors per patient allowed at one time, the daily number of visiting slots, the number of hours open daily, and requisites for hospice ward entry. The differences in visiting policies between hospice wards and ordinary wards were also investigated. Data were collected by reviewing the official website of each hospital and were supplemented by phone calls in cases where no information was posted on the website. One quarter (n = 20) of hospice wards had different visiting policies to those of ordinary wards in the same hospital. Only one hospice ward operated an open policy, and in contrast, nine (11.8%) stopped visits entirely. Among the 67 hospice wards that allowed visiting, at most, two visitors at one time per patient were allowed in 46 (68.6%), one visiting time daily was allowed in 32 (47.8%), one hour of visiting per day was allowed in 29 (43.3%), and checking of identity and travel history was carried out in 12 wards (17.9%). During the COVID-19 pandemic, nearly all hospice wards in Taiwan changed their visiting policies, but the degree of restriction varied. Further studies could measure the impacts of visiting policy changes on patients and healthcare professionals.

Occupational leptospirosis as an underreported disease in high-risk groups: implications for prevention and control measures

Leptospirosis is a neglected zoonotic disease with no particular or verified symptoms, which has been underreported as an occupational infection. Leptospira interrogans serovar Icterohaemorrhagiae and L. interrogans serovar Grippotyphosa are the two major pathogenic serovars. Professionals who are in constant contact with animals and their residues, in water supply, rice mill, slaughtering houses, hospital sanitary places, strawberry picking, construction works, agriculture working, forest working and food industry are at highest risk. Factors related to occupational, environmental, and recreational aspects and the presence of wild reservoirs of leptospirosis will be discussed in this concise review. Noticeably, lack of early identification, international travelling, skin wounds, sanitary and washing habitations after contact with animals, delay in treatment, and unhealthy behaviors of adolescents contribute to the disease. Hence, public education for people's awareness is essential. For instance, farmers, students, forest keepers, veterinary surgeons or veterinarians, and abattoir workers should take care by wearing cloth, such as long trousers and a long-sleeved shirt, and simple gloves to hinder the infection acquisition through skin. For people engaged in water sports, covering skin abrasions with waterproof dressings and wearing protective clothing can prevent disease transmission. However, there is no same control strategy applicable to all epidemiological wards universally. Furthermore, ecoepidemiological and cultural characteristics should be well recognized.

Perencanaan Sistem Instalasi Plambing Air Bersih dengan Penerapan Alat Plambing Hemat Air Di Rumah Sakit Universitas Sam Ratulangi

<p>The hospital is a health service building, a place of transmission of disease and allows environmental pollution and health problems. One of the prevention of disease transmission and environmental pollution, it is necessary to do repairs and improvements by using a plumbing system to have good sanitation and environmental friendly. In this case, needed to know how much water can save by method comparing between plumbing tools conventional and non-conventional standar. UNSRAT’s hospital has a population of 2,962 people who needed clean water distribution of 372,48 m<sup>3</sup>/ day. Compared by using conventional plumbing tools is 66,72 m<sup>3</sup>/hari, meanwhile non-conventional plumbing tools is 39,60 m<sup>3</sup>/hari, it shown that using non-conventional plumbing tools standard is more saving than conventional standard, where percentage non-conventional water saving is 40,64%. Also expected that the resulting domestic wastewater will be reduced by 31,68 m<sup>3</sup>/ day. This is more important than water savings in the amount of Rp. 3.564.000 and domestic wastewater treatment costs Rp. 9.500.000.</p>

Diagnosing sputum smear negative pulmonary tuberculosis patients by transbronchial biopsy and bronchoalveolar lavage smear.

Pulmonary tuberculosis is one of the leading causes of infectious disease related mortality. Transbonchial biopsy and bronchoalveolar lavage smear obtained by bronchoscopy provides greater quantity of material for analysis, thus increases the chances of diagnosing the disease. Objectives: To diagnose sputum smear negative pulmonary tuberculosis patients by Transbronchial Biopsy and Bronchoalveolar smear keeping bronchoalvelar lavage culture as gold standard. To calculate and compare the diagnostic accuracy of transbronchial biopsy and bronchoalveolar lavage smear in sputum negative patients. Study Design: Cross-sectional validation study. Setting: Department of histopathology, Foundation University Medical College, Islamabad and Department of Pulmonology and Microbiology, Fauji Foundation Hospital, Rawalpindi. Period: From May 2016 to May 2017. Materials & Methods: It comprised 96 patients who underwent bronchoscopy. Transbronchial biopsy, bronchoalveolar lavage smear preparation and bronchoalveolar lavage culture was performed on specimens of all patients. Results: Out of 96 patients 22 (22.91%) patients were actually having tuberculosis whereas 74 (77%) had only clinical and radiological suspicion of tuberculosis. The mean age of patients was 43 years with a standard deviation of ±19.1 .The age range was 12-80 years. The sensitivity, specificity, positive predictive value, negative predictive value and true positives of transbronchial biopsy were 68.1%, 77%, 46.8%, 89% and15.62% while the values for bronchoalveolar lavage were 50%, 97.29%, 84.6%, 86.7% and 11.45% respectively. Thus, the diagnostic accuracy calculated for transbronchial biopsy and bronchoalveolar lavage was 75% and 13.54% respectively. Conclusions: Bronchoscopy should be done in all sputum negative tuberculosis patients having strong clinical and radiological suspicion to obtain transbronchial biopsy and bronchoalveolar lavage for timely diagnosis, treatment and prevention of disease transmission as well as to avoid empirical treatment and its side effects in patients having no tuberculosis. The diagnostic accuracy of transbronchial biopsy is almost 5 times more compared to bronchoalveolar lavage smear.

Aedes Mosquito Control and Surveillance in the Pacific

Introduction:
 Mosquitoes of the genus Aedes transmit dengue, Zika and chikungunya viruses, and the incidence of these diseases is increasing in the Pacific. This can be attributed to increased movement of people and goods, unplanned urbanisation, and global warming, among other factors. As vaccines are unavailable, we rely on vector control programs to prevent disease transmission. This study aimed to evaluate current practice in vector control and surveillance in 10 Pacific Island countries and identify evidence-based vector control interventions and surveillance methods for use in these countries.
 
 Methods:
 This study was conducted in preparation for TechCamp New Zealand, 24-26 January 2018, which aimed to work with stakeholders from 10 Pacific nations to reduce the spread of vector-borne diseases in the region. We conducted a literature review of published reviews and meta-analyses evaluating Aedes control and surveillance to find methods appropriate for use in Pacific Island countries. We collected information regarding current Aedes mosquito control and surveillance practice in 10 Pacific countries from TechCamp participants, through a survey, presentation and interview.
 
 Findings:
 Findings include evidence-based vector control interventions and surveillance methods, and current vector control and surveillance practice in 10 Pacific Island countries. Combinations of vector control interventions, applied appropriately, can prevent disease transmission. Although such programs exist in the Pacific, some interventions do not currently follow best practice. Key barriers to implementing evidence-based practice include lack of targeted education, internet and network coverage, personnel and expertise.
 
 Conclusions:
 Future goals for the region include the adaptation of current practice to evidence-based practice, and the development of vector and risk factor surveillance for targeted mosquito control. New developments should be sustainable and not reliant on internet or network real-time coverage. Education should be targeted to local communities to maximise community participation.

Assessment of a Split Homing Based Gene Drive for Efficient Knockout of Multiple Genes.

Homing based gene drives (HGD) possess the potential to spread linked cargo genes into natural populations and are poised to revolutionize population control of animals. Given that host encoded genes have been identified that are important for pathogen transmission, targeting these genes using guide RNAs as cargo genes linked to drives may provide a robust method to prevent disease transmission. However, effectiveness of the inclusion of additional guide RNAs that target separate genes has not been thoroughly explored. To test this approach, we generated a split-HGD in Drosophila melanogaster that encoded a drive linked effector consisting of a second gRNA engineered to target a separate host-encoded gene, which we term a gRNA-mediated effector (GME). This design enabled us to assess homing and knockout efficiencies of two target genes simultaneously, and also explore the timing and tissue specificity of Cas9 expression on cleavage/homing rates. We demonstrate that inclusion of a GME can result in high efficiency of disruption of both genes during super-Mendelian propagation of split-HGD. Furthermore, both genes were knocked out one generation earlier than expected indicating the robust somatic expression of Cas9 driven by Drosophila germline-limited promoters. We also assess the efficiency of ‘shadow drive’ generated by maternally deposited Cas9 protein and accumulation of drive-induced resistance alleles along multiple generations, and discuss design principles of HGD that could mitigate the accumulation of resistance alleles while incorporating a GME.

Antiviral Effectors and Gene Drive Strategies for Mosquito Population Suppression or Replacement to Mitigate Arbovirus Transmission by Aedes aegypti.

The mosquito vector Aedes aegypti transmits arthropod-borne viruses (arboviruses) of medical importance, including Zika, dengue, and yellow fever viruses. Controlling mosquito populations remains the method of choice to prevent disease transmission. Novel mosquito control strategies based on genetically manipulating mosquitoes are being developed as additional tools to combat arbovirus transmission. Genetic control of mosquitoes includes two basic strategies: population suppression and population replacement. The former aims to eliminate mosquito populations while the latter aims to replace wild populations with engineered, pathogen-resistant mosquitoes. In this review, we outline suppression strategies being applied in the field, as well as current antiviral effector genes that have been characterized and expressed in transgenic Ae. aegypti for population replacement. We discuss cutting-edge gene drive technologies that can be used to enhance the inheritance of effector genes, while highlighting the challenges and opportunities associated with gene drives. Finally, we present currently available models that can estimate mosquito release numbers and time to transgene fixation for several gene drive systems. Based on the recent advances in genetic engineering, we anticipate that antiviral transgenic Ae. aegypti exhibiting gene drive will soon emerge; however, close monitoring in simulated field conditions will be required to demonstrate the efficacy and utility of such transgenic mosquitoes.

Evaluation and comparison of tick detachment techniques and technical mistakes made during tick removal.

Tick is among the important ectoparasites of humans and animals. Ticks may transmit disease-causing pathogens to humans. Tick contact may be resulted in several viral and bacterial infections, including Crimean-Congo Hemorrhagic Fever. Timely removal of ticks with appropriate methods is important in prevention of disease transmission. There are many methods reported for tick detachment. In this study, we aimed to evaluate two of them, suture lassoing and freezing and to compare both methods and to examine technical mistakes with these techniques. This study was designed as a prospective cross-sectional study, and included the ticks detached by healthcare professionals or directly by patients who presented to the emergency department due to tick contact. The ticks were recorded as larvae, nymphs, and adults according to their growth period. Ticks detachment types with surgical sutures and removal mistakes were recorded. The majority (77.4%) of the ticks were removed by healthcare professionals and a lower rate by patients themselves with hand (22.6%). No technical mistake was found in 72 (77.4%) patients, and the tick was detached as a whole, while detached broken in 15 (16.1%) patients, and the tick was detached as a whole, but the sutures were attached wrong in six (6.5%) patients. Tick broken off due to technical mistakes was most commonly seen in the ticks removed by the individuals themselves. The results of this study suggest that when appropriately and correctly used, both suture lassoing and tweezers are effective in tick removal. Public awareness-raising and training programs should be increased on this issue.

The 10 Cow Project: Building Mission Sustainability.

Using lessons from a modern parable about the 10-cow bride, a short-term medical missions team created a sustainable program for Ugandans, helping establish businesses for needy families by providing start-up farm animals. Christian nurses can partner with those in veterinary medicine to provide essential training related to health promotion and prevention of disease transmission in order to promote positive long-term outcomes of such projects.

Single-Dose Intranasal Vaccination Elicits Systemic and Mucosal Immunity Against SARS-CoV-2

A safe and durable vaccine is urgently needed to tackle the COVID19 pandemic. The nasal compartment is the first barrier that needs to be breached by the SARS-CoV-2 virus before dissemination to the lung. Despite remarkable progress, current intramuscular vaccines are designed to elicit systemic immunity without conferring mucosal immunity. We report the development of an intranasal subunit vaccine that contains the spike protein and liposomal STING agonist as an adjuvant. This vaccine induces systemic neutralizing antibodies, mucosal IgA in the lung and nasal compartments, and T-cell responses in the lung of mice. Single-cell RNA- sequencing confirmed the coordinated activation of T and B cell responses in a germinal center-like manner within the nasal-associated lymphoid tissues (NALT), confirming its role as an inductive site to enable durable immunity. The ability to elicit immunity in the respiratory tract can prevent the initial establishment of infection in individuals and prevent disease transmission.Funding: This publication was supported by the NIH (U01AI148118) and Owens foundation. XLacknowledges partial funding support from the National Cancer Institute (NIH R15CA182769, P20CA221731, P20CA221696 ) and CPRIT (RP150656). The following reagent was produced under HHSN272201400008C and obtained through BEI Resources, NIAID, NIH: Spike Glycoprotein(Stabilized) from SARS-Related Coronavirus 2, Wuhan-Hu-1, Recombinant from Baculovirus, NR 52308. Supported by the NIH/NCI under award number P30 CA016672 and used the M.D.Anderson ORION core.Conflict of Interest: UH has filed a provisional patent based on the findings in this study. All other authors have no competing interests to declare.Ethical Approval: All the animal experiments were reviewed and approved by UH IACUC.

Comparison of Antibacterial Efficacy of Locally Produced Alcohol Based Hand Sanitizer and Commonly Available Commercial Hand Sanitizer Used in Healthcare Facilities in Uganda

Use of hand sanitizers has become a cornerstone in clinical practice for the prevention of disease transmission between practitioners and patients. There are a number of hand sanitizers sold on the Ugandan market with labels on their packages that claim that the hand sanitizer can kill 99.999% of germs and also there are hospitals that embarked on the local production of alcohol based hand sanitizer whose efficacy data are not locally available. Objective: To evaluate antibacterial efficacy of locally produced alcohol based hand sanitizer and commonly available commercial hand sanitizer used in healthcare facilities in Uganda. Method: This was an in vitro experimental, laboratory-based study of two different brands of hand sanitizers commonly used in healthcare facilities in Uganda and these were compared to a reference standard 60% Isopropyl alcohol. Efficacy was evaluated using standard organisms of Klebsiella pneumoniae American Type Culture Collection (ATCC 13883), Escherichia coli (ATCC 25922), and S. aureus (ATCC 25923) as per prEN12054, a European standard method. The logarithmic and percentage reduction factors (RF) were assessed at baseline and after treatment. Results: Both hand sanitizers studied were able to reduce bacteria by more than 105-fold within 15 seconds. Efficacy was independent of the alcohol concentration in each brand (Saraya 70% and locally made 80% alcohol). Conclusion: All of the hand sanitizers assessed had efficacy that meets World Health Organization (WHO) and PrEN12054 standards. From this study we are in agreement with the use of the locally made hand sanitizer and Saraya. The two hand sanitizers had broad antibacterial spectrum. However, there is a need to evaluate efficacy and organoleptic properties using in vivo studies.