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Antinuclear antibody (ANA)-positive immune thrombocytopenia (ITP) patients have an unsatisfactory prognosis due to the more severe conditions of these patients and poor response to first-line glucocorticoids (GCs). The current study intended to compare the efficacy and safety of AZA plus prednisone and prednisone alone as first-line treatment in ANA-positive ITP patients. Fifteen ANA-positive ITP patients receiving AZA plus prednisone (AZA + GC group) and eighteen ANA-positive ITP patients receiving prednisone alone (GC group) as first-line treatment were retrospectively enrolled. The complete response (CR) rate (60.0% versus 22.2%) (P = 0.038) was increased in the AZA + GC group versus the GC group, while the overall response rate (86.7% versus 55.6%) (P = 0.070) only showed an increasing trend that did not achieve statistical significance. In addition, multivariate analysis revealed that AZA + GC (versus GC) (odds ratio = 31.331, P = 0.018) was independently associated with a higher possibility of achieving CR. Additionally, accumulating relapse-free duration was prolonged in the AZA + GC group versus the GC group (median: 7.8 months versus 3.4 months) (P = 0.038). Additionally, the multivariate analysis suggested that AZA + GC (versus GC) (hazard ratio = 0.306, P = 0.007) was independently correlated with longer accumulating relapse-free duration. The incidence of adverse events did not differ between the two groups (all P > 0.05), and the common adverse events in the AZA + GC group were pneumonia (13.3%), anemia (13.3%), cough (13.3%), nausea (6.7%), and granulocytopenia (6.7%), which were all tolerable and manageable. First-line AZA plus prednisone realizes a better hematological response and relapse-free duration with acceptable adverse events compared to prednisone alone in ANA-positive ITP patients. [ABSTRACT FROM AUTHOR]

A retrospective cohort study was conducted to examine trends in the incidence and burden of pertussis among adults ≥50 years in South Korea, with/without pre-existing chronic obstructive pulmonary disease (COPD) or asthma. The nationwide Health Insurance Review and Assessment Service (HIRA) database was used to identify patients ≥50 years diagnosed with pertussis (2009–2018). Mean annual incidence of pertussis per 100 000 persons and overall mean incidence rate ratios (IRR) were calculated for patients with pre-existing COPD or asthma versus those with neither. Incremental healthcare costs (all-cause and pertussis-related) and healthcare utilisation (number of outpatient visits, emergency room visits, and number and length of hospitalisations) up to 12 months after, compared to 3 months before pertussis diagnosis, were also measured for each group (matched on sex, age, and Charlson Comorbidity Index). Of 1011 pertussis cases, 175 had asthma, 96 had COPD (not mutually exclusive), and 796 had neither. Overall mean pertussis incidence was 2.5, 3.4, and 0.5 for adults with pre-existing COPD, asthma, and those with neither. IRR (95% confidence interval) of pertussis for adults with pre-existing COPD and asthma was 4.9 (4.0–‍6.1) and 6.7 (5.7–7.9). Both COPD-pertussis and asthma-pertussis groups had higher mean incremental all-cause costs and length of hospitalisations than the general-pertussis group 3 months following pertussis diagnosis. In conclusion, individuals ≥50 years in South Korea with pre-existing COPD or asthma were at an increased risk of being diagnosed with pertussis and had higher healthcare resource utilisation than those without these conditions. [ABSTRACT FROM AUTHOR]

Perinatal tuberculosis is a rare disease with high mortality and a challenging diagnosis. We reported a 56-day-old female infant with cough and wheezing. Her mother had miliary tuberculosis. Gastric aspirate smear, tuberculin skin test, blood and sputum culture of the infant were negative. Thoracic computed tomography demonstrated several consolidated patches with diffuse high-density nodular opacities in bilateral lungs. Fiberoptic bronchoscopy was performed to obtain bronchoalveolar lavage fluid, reduce secretion and restore airway patency on 2 days after admission. Mycobacterium tuberculosis was detected by bronchoalveolar lavage fluid Xpert MTB/RIF and rifampicin resistance was negative on 3 days after admission. Appropriate anti-tuberculosis drug was chosen. The infant made a good recovery. Fiberoptic bronchoscopy plays a vital role in diagnosing rapidly and treating perinatal tuberculosis. And it could be promoted as an important approach to the management of perinatal tuberculosis. [ABSTRACT FROM AUTHOR]

The main clinical manifestations of coronavirus disease 2019 (COVID-19) onset are respiratory symptoms, including cough, sputum, and dyspnea. However, a significant proportion of patients initially manifested non-respiratory symptoms, such as fever, myalgia, and diarrhea. Here, we compared the different characteristics and outcomes between the patients with respiratory symptoms and non-respiratory symptoms at illness onset. The patients admitted to the respiratory departments from eight hospitals in Hunan and Guangxi Province with nucleic acid-positive severe acute respiratory syndrome coronavirus (SARS-CoV-2) were recruited. Epidemiological information, clinical manifestations, laboratory findings, and radiological characteristics, treatment regimens, and outcomes data were recorded and analyzed. The median age of the recruited 541 subjects was 43 years (IQR, 33–55). Of the 541 subjects, 404 (74.5%) subjects had initial symptom that were respiratory, while 137 (25.5%) subjects had non-respiratory symptoms. Respiratory COVID-19 subjects had more secondary bacterial infections (8.7% vs 0.0%, P < 0.001), needed the intensive care unit more (9.7% vs 2.2%, P = 0.005), non-invasive ventilation more (7.2% vs 1.5%, P = 0.004), developed ARDS more (11.4% vs 2.2%, P = 0.001) and needed longer time to recover (18.5 vs 16.7 days, P = 0.003) compared to predominately non-respiratory COVID-19 subjects. The multivariate model showed that age (OR = 1.04, P = 0.01), dyspnea (OR = 4.91, P < 0.001) and secondary bacterial infection (OR = 19.8, P < 0.001) were independently associated with development of ARDS among COVID-19 patients. We identify COVID-19 subjects with dyspnea at disease onset who have a worse prognosis. We also demonstrate age and secondary bacterial infections to be independently associated with ARDS development in subjects with COVID-19. ABBREVIATIONS: COVID-19: Coronavirus disease 2019; ARDS: acute respiratory distress syndrome; IQR: interquartile range; ICU: intensive care unit; CDC: Chinese Center for Disease Control and Prevention. [ABSTRACT FROM AUTHOR]

The transport of droplets expelled when coughing is of critical importance for understanding and preventing airborne disease transmission. However, the cough flow structure is complex, and numerous simplifications are often made to the initial flow condition in laboratory and numerical studies. We aim to challenge some of these assumptions, through particle transport experiments from a highly repeatable cough generator with a realistic oral cavity. In the present study the simultaneous transport and deposition of 22–27 μm, 45–53 μm, and 180–212 μm particles was investigated. Hot-wire measurements of the flow field showed the formation of two parallel jets on either side of the tongue, which produced a free shear layer downstream. Quantitative deposition measurements show that particle deposition patterns are strongly dependent on the formed shear layer for the smaller particles but not the largest size. The effect of circulation was characterized using a modified Stokes number of the form given by Davila and Hunt (2001). The scaling analysis and quantitative data both support the conclusion that while the 180–212 μm particles are not strongly affected, the transport and deposition of the smaller particles are influenced by orifice geometry. These results demonstrate that particle transport from a cough, for which most released droplets are below 22 μm, is a strong function of coherent flow structures present in the 3D flow field. [ABSTRACT FROM AUTHOR]

Transparent barriers were installed as a response to the SARS-COV-2 pandemic in many customer-facing industries. Transparent barriers are an engineering control that intercept particles traveling between customers and workers. Information on the effectiveness of these barriers against aerosols is limited. In this study, a cough simulator was used to represent a cough from a customer. Two optical particle counters were used (one on each side of the barrier, labeled customer and worker) to determine the number of particles that migrated around a transparent barrier. Ten configurations were tested with six replicates for both sitting and standing scenarios, representing nail salons and grocery stores, respectively. Barrier efficiency was calculated using a ratio of the particle count results (customer/worker). Barriers had better efficiency (up to 93%) when its top was 9 to 39 cm above cough height and its width was at least 91 cm. Barriers that extended 91 cm above table height for both scenarios blocked 71% or more of the particles between 0.35–0.725 µm and 68% for particles between 1 to 3 µm. A barrier that blocked an initial cough was effective at reducing particle counts. While the width of the barriers was not as significant as the height in determining barrier efficiency it is important that a barrier be placed where interactions between customers and workers are most frequent. Bystander exposure was not taken into consideration along with other limitations. [ABSTRACT FROM AUTHOR]

Respiratory particles produced by breathing, coughing, and speaking or generated during medical procedures serve as important routes for disease transmission. Characterizing the number of particles generated as well as their size distribution is fundamental for guiding policy on infection control. However, sampling such particles carries inherent challenges. Respiratory particles are polydisperse in size, temporally and spatially variable, and emitted in very low concentrations, usually lower than the preexisting aerosol concentration in indoor environments. In addition, they are typically emitted in a highly dynamic, warm and humid jet, leading to further rapid processes, such as dispersion and evaporation. Here, we discuss important considerations for sampling respiratory aerosol, focusing on sampling particles <20 μm in diameter. Instruments capable of counting single-particles within this size range are commercially available. We provide recommendations for experimental protocols and demonstrate the limitations behind such approaches. We highlight the importance of a measurement space with as low a background aerosol concentration as possible, and of sampling for as long as possible to enable accurate quantitation of the size distribution of an aerosol plume. This is particularly important for the larger particles (>5 μm diameter) that are so low in concentration that they may require hours of sampling time to be accurately quantified. We explore the relationship between the flow rates of the exhalation and the sampling instrument and the consequent quantification of particle flux. We also discuss the transport and evaporation dynamics of liquid particles within respiratory jets, and their impacts on conducting aerosol sampling studies. [ABSTRACT FROM AUTHOR]

And non-hemodialysis patients hospitalized with COVID-19. The seroconversion rates in hemodialysis patients with COVID-19 have been reported to increase with time [[5]], but as hemodialysis patients have a deficient immune response [[6]], they may remain SARS-CoV-2 antigen test positive for longer than other patients. Dear Editor, Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an emerging infectious disease that was first reported in December 2019 in Wuhan, China. [Extracted from the article]

Despite the vaccination program's great effectiveness, pertussis outbreaks are still reported with substantial spatial heterogeneity. Thus, this study aimed to investigate the spatio-temporal patterns of pertussis to determine the hot spots with the high-risk transmission in Vietnam from 2015 to 2019. This study was designed as a cluster case study from December 2019 to October 2020 in Hanoi, Vietnam. Data on 564 pertussis cases were collected via the pertussis case report form of the national immunization program and disease surveillance system of the Hanoi Centers for Disease Control and Prevention (CDC) from 2015 to 2019. Knox Test was applied to assess the risk of spreading epidemics by space and time via a program running on R software. The pertussis incidence per 100 000 population was the highest in the inner city, with an average of 2.96/100000 in 2015. An area with an extremely high risk of infection was located within 200 meters away from the pertussis case and within 40 days, apart from the detecting time (Relative risk (RR) = 3 to 222). Sixty-two hot spot clusters were defined, mainly distributed in the inner city areas, while only a few risk clusters belonged to suburban districts. By using well-defined spatio-temporal distributions, a geographical area of high pertussis transmission risk was identified. Our findings play a fundamental part in developing the ongoing and comprehensive database to complete the disease surveillance system and design effective intervention measures. [ABSTRACT FROM AUTHOR]

Computational Fluid Dynamics is used to model airflow and penetrant behaviour under cough reflex in human airway. The airway geometry segment from the oral cavity to the primary bronchi is reconstructed from CT scan images of a human subject in the standing posture. The inlet flow condition is derived from dynamic cough profiles obtained from two subjects. The mathematical model allows the laryngopharyngeal wall of the airway to remodel. A k-ω turbulence model is used to represent the transitional flow. A Lagrangian approach is used to track solid penetrants in the flow field as a function of penetrant size and density. High velocities are predicted at peak expiratory cough phase. The penetrant size significantly influences the particle residence time and drag force is largely responsible for changes in the penetrant momentum. The smaller penetrants act like tracers in the flow and can escape the airway faster than larger penetrants. [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 pandemic has heightened the interest in particle-laden turbulent jets generated by breathing, talking, coughing and sneezing, and how these can contribute to disease transmission. We present quantitative measurement methods for such flows, while exploring and offering improvements for common shortcomings. We generate jets consisting of either liquid droplets or solid particles in an isothermal, quiescent and electrically isopotential experimental chamber that was constructed to control the effects of ambient forcing on jet behavior. For liquid droplets, we find promise in surface deposition analysis based on fluorescent tracer use. For particles, we explore the performance of commercially available adhesive sampling strips and develop conductive grounded carbon tape based sampling strips. We explore ways in which the smallest of thermal gradients or electrostatic charge issues can affect particle dispersion, and suggest practical methods to address these issues. The developed methods are applied to study the simultaneous deposition of ≈ 25, 50 and 200 μm solid particles from a particle laden turbulent jet with a mean velocity of 33.2 m/s. The deposition location as a function of particle size was compared to results from a simple numerical RANS model, and illustrates ways in which imprecise initial or boundary conditions can lead to a notable deviation from experimental results. The differences in deposition pattern seen in experimental and numerical results despite a carefully controlled environment and characterized particle ejection indicate the need for a more stringent numerical model validation, especially when studying fate and transport of mid-range (neither purely aerosol or ballistic) sized particles. [ABSTRACT FROM AUTHOR]

The ongoing Covid-19 is a contagious disease, and it is characterised by different symptoms such as fever, cough, and shortness of breath. Rising concerns about Covid-19 have severely affected the healthcare system in all countries as the Covid-19 outbreak has developed at a rapid rate all around the globe. Intriguing, a clinically used drug, acetazolamide (a specific inhibitor of carbonic anhydrase, CA, EC 4.2.1.1), is used to treat high-altitude pulmonary oedema (HAPE), showing a high degree of clinical similarities with the pulmonary disease caused by Covid-19. In this context, this preliminary study aims to provide insights into some factors affecting the Covid-19 patients, such as hypoxaemia, hypoxia as well as the blood CA activity. We hypothesise that patients with Covid-19 problems could show a dysregulated acid–base status influenced by CA activity. These preliminary results suggest that the use of CA inhibitors as a pharmacological treatment for Covid-19 may be beneficial. [ABSTRACT FROM AUTHOR]

With airborne transmissions found as one of the major transmission routes of SARS-CoV-2, its transmission in airliner cabin environments drew special attention due to high number of imported cases and in-cabin transmissions. This study numerically investigated the transmission of COVID-19 by cough-induced particles in a cabin section of Boeing 737 model. One passenger was coughing in each case, while cough particles with measured size distributions were released during coughs and were tracked using the Lagrangian framework. Outcomes revealed that cough flow released by passengers could develop rapidly into a strong turbulent cough jet, breaking up the local airflow field. The released cough particles were largely dominated by the cough jet within 5 s, especially the first 1.5 s. Deposition of particles under 100 µm were relatively delayed when released from a window-seat location. Small particles (under 50 µm) released by a window-seat passenger were more likely to spread widely in the studied cabin section, which could lead to the highest exposure risks to nearby passengers. Also, due to ventilation design and seating arrangement, cough particles released by the middle-seat passenger were found easily trapped in his/her own local environment. Cough particles released from aisle-seat passengers had the least exposure risk to adjacent passengers. [ABSTRACT FROM AUTHOR]

The highly contagious whooping cough agent Bordetella pertussis has evolved as a human-restricted pathogen from a progenitor which also gave rise to Bordetella parapertussis and Bordetella bronchiseptica. While the latter colonizes a broad range of mammals and is able to survive in the environment, B. pertussis has lost its ability to survive outside its host through massive genome decay. Instead, it has become a highly successful human pathogen by the acquisition of tightly regulated virulence factors and evolutionary adaptation of its metabolism to its particular niche. By the deployment of an arsenal of highly sophisticated virulence factors it overcomes many of the innate immune defenses. It also interferes with vaccine-induced adaptive immunity by various mechanisms. Here, we review data from invitro, human and animal models to illustrate the mechanisms of adaptation to the human respiratory tract and provide evidence of ongoing evolutionary adaptation as a highly successful human pathogen. [ABSTRACT FROM AUTHOR]

New evidence from studies on risk factors for mortality in hemodialysis (HD) patients with COVID-19 became available. We aimed to review the clinical risk factors for fatal outcomes in these patients. We performed meta-analysis using the PubMed, EMBASE, and Cochrane databases. A fixed- or random-effects model was used for calculating heterogeneity. We used contour-enhanced funnel plot and Egger's tests to assess potential publication bias. Twenty-one studies were included. The proportion of males was lower in the survivor group than in the non-survivor group (OR = 0.75, 95% CI [0.61, 0.94]). The proportion of respiratory diseases was significantly lower in the survivor group than in the non-survivor group (OR = 0.42, 95% CI [0.29, 0.60]). The proportion of patients with fever, cough, and dyspnea was significantly lower in the survivor group (fever: OR = 0.53, 95% CI [0.31, 0.92]; cough: OR = 0.50, 95% CI [0.38, 0.65]; dyspnea: OR = 0.25, 95% CI [0.14, 0.47]) than in the non-survivor group. Compared with the non-survivor group, the survivor group had higher albumin and platelet levels and lower leucocyte counts. Male patients might have a higher risk of developing severe COVID-19. Comorbidities, such as respiratory diseases could also greatly influence the clinical prognosis of COVID-19. Clinical features, such as fever, dyspnea, cough, and abnormal platelet, leucocyte, and albumin levels, could imply eventual death. Our findings will help clinicians identify markers for the detection of high mortality risk in HD patients at an early stage of COVID-19. [ABSTRACT FROM AUTHOR]

There is limited information about the clinical characteristics, treatment and outcome of maintenance hemodialysis patients with COVID-19. Moreover, regional differences are also conceivable since the extend and severity of outbreaks varied among countries. In this retrospective, observational, single-center study, we analyzed the clinical course and outcomes of 37 maintenance hemodialysis patients (median age 64 years, 51% men) hospitalized with COVID-19 from 24 March to 22 May 2020 as confirmed by real-time PCR. The most common symptoms at admission were fatigue (51%), fever (43%), dyspnea (38%) and cough (35%). There were 59% mild/moderate patients and 41% severe/critical patients. Patients in the severe/critical group had a significantly higher atherosclerotic burden since diabetic kidney disease and vascular nephropathies were the most common primary kidney diseases and eighty percent of them had coronary heart disease. Also, Charlson comorbidity score was higher in this group. At admission chest X-ray, 46% had ground-glass abnormalities. Overall, 60% patients received hydroxychloroquine, 22% lopinavir–ritonavir, 11% tocilizumab, 24% systemic glucocorticoids, and 54% received prophylactic anticoagulation. Seven (19%) patients died during hospitalization and 30 were discharged. The main causes of death were cardiovascular (5 patients) and respiratory distress syndrome (2 patients). In Cox regression analysis, lower oxygen saturation, anemia and hypoalbuminemia at admission were associated with increased mortality. In conclusion, we observed a high mortality rate among maintenance hemodialysis patients hospitalized for COVID-19. Anemia, lower serum albumin and lower basal oxygen saturation at admission were factors associated with poor prognosis. [ABSTRACT FROM AUTHOR]

Objective: The 8p11 myeloproliferative syndrome [EMS] is a rare myeloproliferative disorder which usually develops rapidly with chromosomal translocation of the fibroblast growth factor receptor 1 gene. The gene has 15 fusion partners, including the breakpoint cluster region (BCR) gene on chromosome 22. Of all the tests available, chromosome karyotype determination is the most important for the diagnosis of EMS. Here, we describe one case of a patient characterized by marked increase of white blood cells and thrombocytopenia and diagnosed as EMS with t(8;22)(p11;q11) by chromosome karyotype. Methods: 28-year-old man was referred to our hospital. He had a onemonth history of intermittent coughing and a small amount of expectoration after catching a cold. As an outpatient, his complete blood count showed: WBC was 130.04 × 109/L with 80.20% granulocytes.Hematologic investigations, bone marrow analysis and genomic DNA sequencing studies were performed. Results: Despite additional chromosomal abnormalities,the patient progressed rapidly with a B blast cell clone in one month. After diagnosis inthree months, the patient underwent the haplo-identical BMT of his brother, followed up for three years, and had a high rate of survival. Conclusions: Our report provides a definite conceptual framework for a better understanding of the characteristics of The 8p11 myeloproliferative syndrome [EMS]. [ABSTRACT FROM AUTHOR]

Universal mask wearing is recommended to help control the spread of COVID-19. Masks reduce the expulsion of aerosols of respiratory fluids into the environment (called source control) and offer some protection to the wearer. Masks are often characterized using filtration efficiency, airflow resistance, and manikin or human fit factors, which are standard metrics used for personal protective devices. However, none of these metrics are direct measurements of how effectively a mask blocks coughed and exhaled aerosols. We studied the source control performance of 15 cloth masks (face masks, neck gaiters, and bandanas), two medical masks, and two N95 filtering facepiece respirators by measuring their ability to block aerosols ≤7 µm expelled during simulated coughing and exhalation (called source control collection efficiency). These measurements were compared with filtration efficiencies, airflow resistances, and fit factors measured on manikin headforms and humans. Collection efficiencies for the cloth masks ranged from 17% to 71% for coughing and 35% to 66% for exhalation. Filtration efficiencies for the cloth masks ranged from 1.4% to 98%, while the fit factors were 1.3 to 7.4 on headforms and 1.0 to 4.0 on human subjects. The Spearman's rank correlation coefficients between the source control collection efficiencies and the standard metrics ranged from 0.03 to 0.68 and were significant in all but two cases. However, none of the standard metrics were strongly correlated with source control performance. A better understanding of the relationships between source control collection efficiency, filtration efficiency, airflow resistance, and fit factor is needed. [ABSTRACT FROM AUTHOR]

Introduction: Central venous catheter (CVC) placement is one of the most commonly performed procedures in the intensive care unit for the institution of high-risk medications and nutrients. Despite the frequent use of ultrasound, inadvertent placement of CVC into the carotid artery is still possible. It carries significant morbidity due to the incidence of bleeding, arteriovenous fistula, and stroke. Methods: We present a case of accidental placement of CVC into the right carotid artery, which led to the right-sided temporoparietal stroke. Case Summary: A 71-year-old male was admitted to hospital with symptoms of cough, fatigue, and shortness of breath. He was diagnosed with coronavirus disease-19 and did require mechanical ventilation due to progressive hypoxic respiratory failure. The patient developed distributive shock and underwent CVC placement at the day of admission. On the 24th day of intubation, the patient was unable to move his left upper and lower extremities. Computed tomography (CT) head revealed showed a large temporoparietal stroke. CT Angiogram of head and neck revealed a misplaced CVC within the right common carotid artery. He was transferred to the Neuro ICU at our hospital where the patient underwent catheter removal and carotid artery sheath placement followed by dual antiplatelet therapy. Although the patient survived, he still required long-term facility placement due to the stroke. Conclusion: We reiterate that an experienced clinician must perform the CVC placement with ultrasound guidance and verify its placement with multiple confirmation techniques afterwards. Providers must manage unintentional carotid artery placement promptly to prevent long-term sequelae associated with it. [ABSTRACT FROM AUTHOR]

A short distance between infected persons and exposed persons can probably result in a high risk of respiratory infection. This work experimentally investigated the short-range bioaerosol deposition and inhalation by a healthy person (HP) and the effect of a personalized ventilation (PV) on the HP, who was exposed to cough droplets from an infected person (IP) over a short distance between 0.5 m and 1.2 m. Benign E. coli was employed to represent the pathogen from the respiratory droplets. The microorganism deposition on different locations of the HP's body (shoulder, chest and body back) and face (forehead, cheek, and chin) as well as inhalation were characterized by a cultivation method. It was found that the inhalation and deposition of vital pathogens on the face and body surface of the HP increased as the distance between the HP and the IP decreased. PV has been showed to reduce exposure by inhalation, while this is the first time to demonstrate that PV can also significantly reduce the number deposition. By optimizing the velocity of PV flow with respect to the distance, the bioaerosol deposited on the face and body and inhaled could be reduced by a maximum of 98%, 85% and 100%, respectively. For short-range disease transmission, physical barriers, e.g., mask and partition, are the conventional and believed to be the only intervention measures. The current results indicate that PV can be a potential method for infection control in the area of disease transmission in close contact situations. Copyright © 2021 American Association for Aerosol Research [ABSTRACT FROM AUTHOR]

Exposure to respiratory droplets contributes greatly to the spread of SARS-CoV-2 virus during the COVID-19 pandemic. This study investigates the effectiveness of various face coverings to reduce cough-generated airborne particle concentrations at 0.3, 0.9, and 1.8 m away from the source in an indoor environment. We measured the particle number concentration (PNC) and particle size distribution under seven different conditions: (1) no face covering; (2) face shield only; (3) cloth mask; (4) face shield + cloth mask; (5) surgical mask; (6) face shield + surgical mask; (7) N95 respirator or equivalent (i.e., KN95 mask). We observed significant increases in PNCs at 0.3 m under conditions #1-4 and a trend toward an increase at 1.8 m, compared to the background. The face shield by itself provided little protection with a particle reduction of 4 ± 23% relative to no face covering, while the cloth masks reduced the particles by 77 ± 7%. Surgical and N95/KN95 masks performed well and substantially reduced the cough droplets to ≤6% at 0.3 m. In this study, most cough-generated particles were found less than 2.5 µm with an average mode diameter of ∼0.6 µm at 0.3 m. Approximately 80% of the particles ≤2.5 µm were able to travel to 0.9 m, and 10% of the particles ≤1.1 µm likely reached 1.8 m. Based on these results, face coverings, especially surgical and N95/KN95 masks, should be recommended as effective preventive measures to reduce outward transport of respiratory droplets during the COVID-19 pandemic. Copyright © 2020 American Association for Aerosol Research [ABSTRACT FROM AUTHOR]

Keywords: E-cigarette or Vaping Product Use Associated Lung Injury; Bronchoalveolar Lavage; Critical Care; Oil Red O Stain; Pneumonia EN E-cigarette or Vaping Product Use Associated Lung Injury Bronchoalveolar Lavage Critical Care Oil Red O Stain Pneumonia 65 68 4 01/29/21 20210101 NES 210101 1. A suspicion for an e-cigarette or vaping product use associated lung injury (EVALI) prompted the patient to be started on stress dose methylprednisolone. Evaluation of bronchoalveolar lavage fluid from patients in an outbreak of E-cigarette, or vaping, product use-associated lung injury - 10 states, august-october 2019. E-cigarette or Vaping Product Use Associated Lung Injury, Bronchoalveolar Lavage, Critical Care, Oil Red O Stain, Pneumonia. [Extracted from the article]

Pertussis, commonly known as 'whooping cough', can affect all age groups and occurs at any time during the year. The aim was to estimate the current health and economic burden of pertussis-associated disease in Bulgaria. We also analyzed the cost-benefit and financial consequences of introducing (since 1st January 2020) an acellular pertussis (acP) booster dose at the age of 12 into the immunization schedule of Bulgaria. A combined pharmacoeconomic (cost-benefit and budget impact analysis) and a population-based screening cohort study was performed. It included 202 women in reproductive age (20 to 39 years). Fifty-one percent had only one child and 49% had two or more children. Over 70% of all the 202 women had an average of 3.75 IU/mL IgG-anti-PT (indication for waning pertussis protection) and 1.5% had >100 IU/mL IgG-anti-PT, which indicate a recent infection. Bulgaria has low pertussis morbidity, as the reported cases are limited, compared to the the average in the European Union and there have been no death cases in the last 10 years. However, significant pertussis infections remain unreported but still occur in the adult population. An acP booster dose, at the age of 12, was projected to give significant potential savings from the reduced number of physician and hospitalization visits, ambulatory care and indirect costs. The budget impact of a booster dose was expected to decrease from 4.45 million BGN to 3.9 million BGN. The acP booster dose would lead annually to around 4.2 million BGN and avoid the active cases with seven. [ABSTRACT FROM AUTHOR]

Globally, the agenda is to end tuberculosis (TB) by 2030. The emic (local) perspective about causes, signs and symptoms, and management of the disease has implications in service utilization and health-seeking. This research paper examines the local beliefs about TB and how this affects case detection and treatment. The analysis triangulates data from eight focus group discussions (N = 72), 15 in-depth interviews (IDIs) with patients with TB, and four traditional healers. TB described locally as Kɔrongkpong, kɔrongpilah (in Dagaare), and Kusibine (in Sissalla) is believed to be caused by curses, bewitchment, breaking local taboos, and a sin against the gods. The ethnosemantics depict TB as a condition of the lungs which presents with severe cough, caused by spiritual factors with fatal health outcome. In that regard, traditional medicine to exorcise the spirit is required before modern medicine can be effective. Initial symptoms such as cough and fever of TB are often self-managed and later traditional remedies sought. Furthermore, some of the signs are misconstrued for conditions such as asthma and whooping cough. The worldview of the community also dictates that these conditions have spiritual aetiologic factors and should be managed as such. This health-seeking pattern results in delays in receiving appropriate treatment. As an infectious disease, the delays in health-seeking will hinder progress towards achieving the end TB global agenda. Incorporating local beliefs into the design of interventions and social and behavioural change communication strategies can help improve case detection and treatment. [ABSTRACT FROM AUTHOR]

Undifferentiated pleomorphic sarcoma (UPS) is a highly aggressive cancer that most commonly occurs in the extremities and trunk but is extremely rare in the kidney. This study reports a 60-year-old woman with obstinate cough and fever as the first symptoms and an initial diagnosis of inflammatory lung disease. However, none of the symptoms improved after one month of treatment. A repeated chest computed tomography (CT) scan suggested a huge renal mass in the left kidney; therefore, a radical nephrectomy was finally performed in the urology department. And the postoperative pathological examinations revealed UPS. Interestingly, the bothersome symptoms of the patient magically disappeared on the 2nd day after the surgery. During a follow-up of 32 months, there was no sign of recurrence. We found that early diagnosis together with thorough surgical treatment is currently the most effective approach to prolong the survival time of patients. In addition, postoperative radiotherapy and chemotherapy could be alternative options to benefit patients. [ABSTRACT FROM AUTHOR]

The highly contagious whooping cough agent Bordetella pertussis has evolved as a human-restricted pathogen from a progenitor which also gave rise to Bordetella parapertussis and Bordetella bronchiseptica. While the latter colonizes a broad range of mammals and is able to survive in the environment, B. pertussis has lost its ability to survive outside its host through massive genome decay. Instead, it has become a highly successful human pathogen by the acquisition of tightly regulated virulence factors and evolutionary adaptation of its metabolism to its particular niche. By the deployment of an arsenal of highly sophisticated virulence factors it overcomes many of the innate immune defenses. It also interferes with vaccine-induced adaptive immunity by various mechanisms. Here, we review data from in vitro, human and animal models to illustrate the mechanisms of adaptation to the human respiratory tract and provide evidence of ongoing evolutionary adaptation as a highly successful human pathogen. [ABSTRACT FROM AUTHOR]

The mucosal immune system serves as the first line of defense against Bordetella pertussis. Intranasal vaccination, due to its potential to induce systemic and mucosal immune responses, appears to prevent the initial adherence and colonization of the bacteria at the first point of contact. In the present study, two B. pertussis antigens, pertussis Toxoid (PTd) and Filamentous hemagglutinin (FHA), which play a very significant role in virulence and protection against pertussis, were encapsulate into N-trimethyl chitosan (TMC) nanoparticulate systems. After preparation of TMC nanoparticles (NPs), the NPs were characterized and their ability to induce efficient immune responses against B. pertussis was studied in a mouse model. Our findings showed that PTd + FHA-loaded TMC NPs have strong ability to induce IL-4, IL-17, IFN-γ, IgG, and IgA in the mouse model. Results from this study suggest that nasal administration of the PTd + FHA-loaded TMC NPs induced not only a systemic immune response but also a local mucosal response, which may improve the efficacy of pertussis prevention through respiratory tract transmission. [ABSTRACT FROM AUTHOR]

Background: The national tuberculosis (TB) programme in India recommends screening all pregnant women for TB, but this is rarely implemented. We carried out systematic TB screening among women attending the antenatal clinic of a tertiary care hospital in Puducherry, South India, during February to April 2018. Objective: To assess the number screened and number (proportion) with presumptive and active TB, and understand potential implementation from the healthcare providers' perspective. Methods: We conducted a mixed-methods study. The quantitative phase was a cross-sectional study including 4203 pregnant women. Data were captured using a structured proforma. Any of the following symptoms constituted 'presumptive TB': any cough, haemoptysis, fever, weight loss, night sweats, neck swellings, joint pains, neck stiffness and disorientation. Those screening positive were referred for investigations and evaluation by a chest physician. The qualitative phase involved seven one-to-one interviews with healthcare providers. Manual thematic analysis was performed to generate themes. Results: Among 4203 women (two HIV-positive) screened, 77 (1.8%) had presumptive TB. Cough was the predominant symptom (n = 75). Only 12 women could produce a sputum sample, of whom one (0.02%) was diagnosed with active TB by the Xpert MTB/RIF assay. Challenges cited by healthcare providers were lack of awareness among clients and providers, high case load, lack of dedicated staff, perception that TB screening is a low-yield, low-priority activity and losses in the referral process. Suggested solutions were providing dedicated staff and space for screening, educating women to self-report using posters and videos, and creating a one-stop care provision. Conclusions: The TB yield among pregnant women was very low, calling into question the value of systematic screening in a low-HIV setting. However, the findings may not be generalizable. Evidence is urgently needed from primary and secondary care facilities. The challenges and solutions identified may help in optimizing the screening process. [ABSTRACT FROM AUTHOR]

Maternal antibodies induced by vaccination during pregnancy cross the placental barrier and can close the susceptibility gap to pertussis in young infants up to the start of primary immunization. As not only the quantity but also the quality of circulating antibodies is important for protection, we assessed whether maternal immunization affects the avidity of infant vaccine-induced IgG antibodies, in the frame of a prospective clinical trial on pregnancy vaccination in Belgium. Infants born from Tdap (Boostrix®) vaccinated (N = 55) and unvaccinated (N = 26) mothers were immunized with a hexavalent pertussis containing vaccine (Infanrix Hexa®) at 8, 12 and 16 weeks, followed by a fourth dose at 15 months of age. Right before and one month after this fourth vaccine dose, the avidity of IgG antibodies against diphtheria toxin (DT), tetanus toxin (TT), pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (Prn) was determined using 1.5 M ammonium thiocyanate as dissociating agent. In both groups, antibody avidity was moderate for TT, PT, FHA and Prn and low for DT after priming. After a fourth dose, antibody avidity increased significantly to high avidity for TT and PT, whereas it remained moderate for FHA and Prn and low for DT. The avidity correlated positively with antibody level in both study groups, yet not significantly for PT. When comparing both study groups, only PT-specific antibodies showed significantly lower avidity in infants born from vaccinated than from unvaccinated mothers after the fourth vaccine dose. The clinical significance of lower avidity of vaccine induced infant antibodies after maternal vaccination, if any, needs further investigation. [ABSTRACT FROM AUTHOR]

Background: Despite significant achievements in health indicators during previous decades, Vietnam lags behind other developing countries in reducing common early childhood illnesses, such as diarrhea and respiratory infections. To date, there has been little research into factors that contribute to the prevalence and treatment of childhood morbidity in Vietnam. Objective: This study examines the determinants of diarrhea and 'illness with a cough' and treatments for each of the conditions among young children in Vietnam, and describes trends over time. Design: Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. Multivariable logistic regressions were undertaken to investigate factors associated with these childhood illnesses and proper treatment patterns. Results: Between 2000 and 2011, the prevalence of diarrhea among children under the age of five declined from 11 to 7%, while having illness with a cough increased to 40% in 2011 after falling from 69 to 28% between 2000 and 2006. During the same period, the prevalence of oral rehydration therapy (ORT) for treating diarrhea increased from 13 to 46%, whereas the rate of seeking formal treatment for illnesses with a cough fell from 24 to 7%. Multivariable models indicated that children who were older than 2 years (odds ration [OR]: 0.44, 95% confidence interval [CI]: 0.37-0.53, p<0.001), male (OR: 1.21, 95% CI: 0.64-2.37, p<0.05), living in rural areas (OR: 1.28, 95% CI: 1.00-1.64, p

Background: Despite significant achievements in health indicators during previous decades, Vietnam lags behind other developing countries in reducing common early childhood illnesses, such as diarrhea and respiratory infections. To date, there has been little research into factors that contribute to the prevalence and treatment of childhood morbidity in Vietnam. Objective: This study examines the determinants of diarrhea and 'illness with a cough' and treatments for each of the conditions among young children in Vietnam, and describes trends over time. Design: Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. Multivariable logistic regressions were undertaken to investigate factors associated with these childhood illnesses and proper treatment patterns. Results: Between 2000 and 2011, the prevalence of diarrhea among children under the age of five declined from 11 to 7%, while having illness with a cough increased to 40% in 2011 after falling from 69 to 28% between 2000 and 2006. During the same period, the prevalence of oral rehydration therapy (ORT) for treating diarrhea increased from 13 to 46%, whereas the rate of seeking formal treatment for illnesses with a cough fell from 24 to 7%. Multivariable models indicated that children who were older than 2 years (odds ration [OR]: 0.44, 95% confidence interval [CI]: 0.37-0.53,p < 0.001), male (OR: 1.21,95% CI: 0.64-2.37, p <0.05), living in rural areas (OR: 1.28,95% CI: 1.00-1.64,p <0.05), or of Kinh ethnicity (OR: 0.70,95% CI: 0.56-0.87,p <0.01) were more likely to suffer from diarrhea. Ethnic differences and higher household wealth were factors significantly associated with having illness with a cough. In particular, the effect of level of wealth on illness with a cough varied in each wave. Mothers with higher levels of education had higher odds of seeking ORT compared with mothers with the lowest level of education. Seeking formal treatment for children who have illness with a cough was associated with being in a household in the richest wealth quintile (OR: 0.56, 95% CI: 0.34-0.91, p <0.05). Conclusions: This study demonstrates the importance of identifying different risk factors for these two illnesses and also factors associated with healthcare-seeking behaviors in order to reduce the burden of childhood morbidity in Vietnam. Policies aimed at tackling childhood morbidities should include comprehensive strategies that impact on socioeconomic and environmental factors. [ABSTRACT FROM AUTHOR]

This article presents analytical and experimental results for the velocity distribution and transport of expiratory particles from an artificial cough. The stream-wise penetration distance and velocity field of the cough jet were determined through a combination of dimensionless analysis and experimental techniques. The experiments were conducted in a well-controlled environmental chamber with simplified thermal manikins to simulate human coughs and buoyant thermal plumes, and involved flow visualization, velocity measurements employing high and low velocity hot-wire anemometers, and particle size and concentration measurement. The study analyzed three particle sizes—0.77, 2.5, and 7 μm—to examine the impact of particle size on particle transport in the cough jet region and in the vicinity of a receiver occupant positioned in close proximity to the coughing source. The results indicate that the cough jet has a lower axial velocity but higher span-wise expansion rate than a steady jet with an identical discharge velocity. The particles of three sizes have a similar trajectory when considering the transport in the cough jet region. However, particle concentration distributions of the three size particles show that size is an important factor for particle transport in the vicinity of the receiver occupant where airflow velocity decays to the room background air velocity. Furthermore, the results suggest that a cough jet is able to overcome the buoyant human thermal plume and travel further ahead in the region behind the receiver occupant. Copyright 2014 American Association for Aerosol Research [ABSTRACT FROM AUTHOR]

A tracheoesophageal fistula (TEF), albeit rare, can be a life-threatening condition that requires prompt identification and treatment. Pulmonary contamination and restriction of proper nutrition are common, unfortunate consequences of untreated TEFs and are often the causes of mortality in this population. In our patient, a history of laryngeal malignancy along with symptoms of chest pain and cough with ingestion of liquids, even without evidence of aspiration pneumonia, appropriately prompted investigation for potential TEF. Initial imaging through barium swallow identified the TEF, and the patient underwent treatment with endoclips by endoscopy with bronchoscopic assistance. [ABSTRACT FROM AUTHOR]

Globally, diarrhoea and acute respiratory infections (ARIs) have been identified as major threats to child survival. In Ghana, the two conditions are among the top three causes of morbidity and mortality among children under 5 years. An in-depth analysis of the factors associated with these two diseases is warranted, because of their high degree of fatality and also it provides a basis for intervention planning. To investigate socio-demographic and environmental factors associated with infectious disease morbidity in children under 5 years old in Ghana. Population-based cross-sectional survey. The study sample comprised 2,790 children aged 0–59 months, drawn from the Ghana Demographic and Health Surveys. The mothers reported whether their children under age 5 had been ill with a cough accompanied by short, rapid breathing (ARI), or diarrhoea with the presence of blood or mucus in the stool, in the 2 weeks preceding the survey. Children in the 6–11, 12–23, and 24–59 months age groups had, respectively, 3.48 (95% CI=2.23, 5.44), 4.57 (95% CI=3.03, 6.90), and 1.93 (95% CI=1.30, 2.87) increased odds of getting diarrhoea infection compared to those in the youngest age category (0–5). Similarly, children in the 6–11, 12–23, and 24–59 months age brackets were, respectively, 2.64 (95% CI=1.76, 3.97), 2.63 (95% CI=1.81, 3.83), and 1.83 (95% CI=1.29, 2.59) times more likely to have cough compared to children in 0–5 months age brackets. Children who were not breastfeeding had higher odds of childhood diarrhoea (OR=1.33, 95% CI=1.03, 1.73) compared to those who were breastfeeding. Compared to children who were living in households without co-wives, children who were living in households with co-wives had 1.74 increased odds of diarrhoea (95% CI=1.33, 2.27). A unit increase in maternal opinion regarding wife beating was associated with 14% reduced odds of diarrhoea (OR=0.86, 95% CI=0.80, 0.91), while a unit change in the women's attitude towards sex index was associated with 14% reduced odds of childhood cough (OR=0.86, 95% CI=0.77, 0.97). Our results show that breastfeeding, polygamous marriage, and maternal decision-making autonomy are significant predictors of child morbidity. Therefore, implementing effective educational programmes that aim at promoting breastfeeding, empowering women, and discouraging polygamous marriages could help save many children from infectious disease morbidity in Ghana. [ABSTRACT FROM AUTHOR]

Infectious disease surveillance has long been a challenge for countries like India, where 75% of the health care services are private and consist of both formal and informal health care providers. Infectious disease surveillance data are regularly collected from governmental and qualified private facilities, but not from the informal sector. This study describes a mobile-based syndromic surveillance system and its application in a resource-limited setting, collecting data on patients' symptoms from formal and informal health care providers. The study includes three formal and six informal health care providers from two districts of Madhya Pradesh, India. Data collectors were posted in the clinics during the providers' working hours and entered patient information and infectious disease symptoms on the mobile-based syndromic surveillance system. Information on 20,424 patients was collected in the mobile-based surveillance system. The five most common (overlapping) symptoms were fever (48%), cough (38%), body ache (38%), headache (37%), and runny nose (22%). During the same time period, the government's disease surveillance program reported around 22,000 fever cases in one district as a whole. Our data – from a very small fraction of all health care providers – thus highlight an enormous underreporting in the official surveillance data, which we estimate here to capture less than 1% of the fever cases. Additionally, we found that patients from more than 600 villages visited the nine providers included in our study. The study demonstrated that a mobile-based system can be used for disease surveillance from formal and informal providers in resource-limited settings. People who have not used smartphones or even computers previously can, in a short timeframe, be trained to fill out surveillance forms and submit them from the device. Technology, including network connections, works sufficiently for disease surveillance applications in rural parts of India. The data collected may be used to better understand the health-seeking behaviour of those visiting informal providers, as they do not report through any official channels. We also show that the underreporting to the government can be enormous. [ABSTRACT FROM AUTHOR]

Delay by men in seeking healthcare results in their higher mortality while on HIV or tuberculosis (TB) treatment and contributes to ongoing community-level disease transmission before going on treatment. To understand masculinity's role in delay in healthcare seeking for men, with a focus on TB-suggestive symptoms. Data were collected between March 2011 and March 2012 in low-income suburbs in urban Blantyre using focus group discussions with community members (n=8) and health workers (n=2), in-depth interviews with 20 TB patients (female=14) and 20 uninvestigated chronic coughers (female=8), and a 3-day participatory workshop with 27 health stakeholder representatives. The research process drew to a large extent on grounded theory principles in the manner of Strauss and Corbin (1998) and also Charmaz (1995). Role descriptions by both men and women in the study universally assigned men as primary material providers for their immediate family, that is, the ones earning and bringing livelihood and additional material needs. In a context where collectivism was valued, men were also expected to lead the provision of support to wider kin. Successful role enactment was considered key to achieving recognition as an adequate man; at the same time, job scarcity and insecurity, and low earnings gravely impeded men. Pressures to generate continuing income then meant constantly looking for jobs, or working continuously to retain insecure jobs or to raise money through self-employment. All this led men to relegate their health considerations. Early engagement with formal healthcare is critical to dealing with TB and HIV. However, role constructions as portrayed for men in this study, along with the opportunity costs of acknowledging illness seem, in conditions of vulnerability, important barriers to care-seeking. There is a need to address hidden care-seeking costs and to consider more complex interventions, including reducing precarity, in efforts to improve men's engagement with their health. [ABSTRACT FROM AUTHOR]