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Background: COVID‐19 is a highly contagious virus that causes pneumonia, which quickly progresses to acute respiratory distress. In the case of COVID‐19, physiotherapy is critical in non‐invasive support management, postural changes, chest physiotherapy (CPT), and bed mobility. This study aims to look into the effects of physiotherapy intervention on functional outcome levels in COVID‐19 patients in the acute stage. Methods: A total of 60 severe COVID‐19 patients (54 males and 6 females) with a mean age of 50 years were studied. The intervention group (n = 30) had two daily physiotherapy sessions that included positioning, CPT, cardio exercises, breathing exercises, and early mobility, whereas the control group (n = 30) received only standard medical care. Patients were tested twice at the baseline and discharge using peripheral oxygen saturation, respiratory rate (RR) test, dyspnea rate, two‐min walk test, and spirometer scores, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Results: The two groups improved significantly between the baseline and discharge ratings. The intervention group, on the other hand, significantly improved all outcome indicators at discharge (p‐value = 0.00). This study found that physiotherapy management improved oxygen saturation, RR, dyspnea, and lung function tests in COVID‐19 patients except in FVC (p‐value = 0.402) and FEV1(p‐value = 0.114). Conclusion: Physiotherapist interventions with COVID‐19 patients increase respiratory function and treatment time. [ABSTRACT FROM AUTHOR]

During the coronavirus disease 2019 (COVID‐19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), viral transport, fate, disinfection and environmental release in wastewater treatment plants have been issues of high importance for overall management. Although a huge number of scientific publications related to coronaviruses have been published, the number of studies on different aspects of wastewater treatment strategies to deal with SARS‐CoV‐2 abatement is still relatively limited and results are often confusing. To define real wastewater risks for public health and the environment, we have performed a systematic review and identified 96 papers from the PubMed database. We focused on SARS‐CoV‐2 wastewater treatments and how the type and level of treatments affect the virological quality of the effluents, the role of disinfectants, the treatment of medical wastewater, the role of new technologies, as well as the wastewater treatment in low‐ and middle‐income countries. It was concluded that, in general, well‐designed and well‐functioning wastewater treatment plants (WWTPs) and on‐site reliable sanitation systems may significantly limit the risk of SARS‐CoV‐2. The development of cost‐effective decentralized water and wastewater treatment facilities for low‐ and middle‐income countries for the abatement of coronaviruses should be enhanced. Lessons learned during the COVID‐19 pandemic with regard to wastewater treatment are expected to support an improved detection, response and containment of future viral disease outbreaks. © 2023 The Authors. Journal of Chemical Technology and Biotechnology published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry (SCI). [ABSTRACT FROM AUTHOR]

The hospital environment can be considered a high risk for the occurrence of SARS‐CoV‐2 transmission outbreaks, either for health professionals who are directly involved in the care of suspected or confirmed cases of the disease, or for patients, for being in an environment more vulnerable to the acquisition of nosocomial infections. In this molecular epidemiology study, we aimed to analyze the occurrence and transmission dynamics of SARS‐CoV‐2 in outbreaks and local chains of transmission in a large tertiary teaching hospital in southern Brazil, in addition to verifying circulating strains and their epidemiological relation in the local context, from September 21, 2020 to October 5, 2021. Positive samples involved in COVID‐19 clusters or outbreaks were analyzed using clinical, epidemiological and genomic data. Different lineages and sublineages among patients in the same room were observed. Most patients had their first clinical manifestation, evidence of suspicion, and diagnostic confirmation within 7–14 days or >14 days after hospital admission. The patients who have contact with confirmed cases of COVID‐19 spent, on average, 6.28 days in the same environment until the positive test. There was a significant association between the outcome and the number of vaccine doses (p < 0.05), where those who received two doses presented a lower occurrence of death. There was a total replacement of variant of concern (VOC) Gamma by VOC Delta from August 2021 at the study site. Although the epidemiological analysis indicates nosocomial infections, through genomic sequencing, it was established that most of the hospital outbreaks had different origins. These findings highlight the utility of integrating epidemiological and genomic data to identify possible routes of viral entry and dissemination. [ABSTRACT FROM AUTHOR]

Objective: To offer pragmatic, evidence-informed advice on administering corticosteroids in otolaryngology during the coronavirus disease 2019 (COVID-19) pandemic, considering therapeutic efficacy, potential adverse effects, susceptibility to COVID-19, and potential effects on efficacy of vaccination against SARS-CoV-2, which causes COVID-19. Data Sources: PubMed, Cochrane Library, EMBASE, CINAHL, and guideline databases. Review Methods: Guideline search strategies, supplemented by database searches on sudden sensorineural hearing loss (SSNHL), idiopathic facial nerve paralysis (Bell's palsy), sinonasal polyposis, laryngotracheal disorders, head and neck oncology, and pediatric otolaryngology, prioritizing systematic reviews, randomized controlled trials, and COVID-19–specific findings. Conclusions: Systemic corticosteroids (SCSs) reduce long-term morbidity in individuals with SSNHL and Bell's palsy, reduce acute laryngotracheal edema, and have benefit in perioperative management for some procedures. Topical or locally injected corticosteroids are preferable for most other otolaryngologic indications. SCSs have not shown long-term benefit for sinonasal disorders. SCSs are not a contraindication to vaccination with COVID-19 vaccines approved by the US Food and Drug Administration. The Centers for Disease Control and Prevention noted that these vaccines are safe for immunocompromised patients. Implications for Practice: SCS use for SSNHL, Bell's palsy, laryngotracheal edema, and perioperative care should follow prepandemic standards. Local or topical corticosteroids are preferable for most other otolaryngologic indications. Whether SCSs attenuate response to vaccination against COVID-19 or increase susceptibility to SARS-CoV-2 infection is unknown. Immunosuppression may lower vaccine efficacy, so immunocompromised patients should adhere to recommended infection control practices. COVID-19 vaccination with Pfizer-BioNTech, Moderna, or Johnson & Johnson vaccines is safe for immunocompromised patients. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is a viral pathogen that quickly became a global pandemic in the winter of 2020–2021. In response, governments issued social distancing orders to minimize transmission by reducing community contacts. We tested the efficacy of this social distancing at the state level during the first 2 months of the pandemic in the United States. We utilized data on daily SARS‐CoV‐2 case numbers and human community mobility (anonymized, aggregated cell phone location data stratified into six categories used as an index of social distancing), the date of government‐issued social distancing orders, demographics, urbanization and public transportation. We implemented cross‐correlation to identify lag times between declines in mobility and SARS‐CoV‐2 cases. Incorporating state‐specific lag times, we tested for associations between case counts and mobility metrics using Bayesian multilevel models. Decreased mobility around grocery stores/pharmacies, retail/recreation locations, transit stations and workplaces was correlated with decreases in SARS‐CoV‐2 cases with significant lag times of ≥21 days. Social distancing orders were associated with fewer cumulative SARS‐CoV‐2 cases when they were put in place earlier. Community mobility had already started declining prior to most social distancing orders, especially the more restrictive orders implemented later in the pandemic. Social distancing is an important tool that has been implemented throughout the pandemic to decrease SARS‐CoV‐2 transmission, although with significant social and economic impacts. Our results suggest that declines in cases were observed several weeks subsequent to implementation of social distancing measures, and that implementing social distancing earlier could potentially minimize the duration of time these policies need to be in effect. Our findings can inform ongoing management of this pandemic and other emerging infectious disease outbreaks by identifying areas where reductions in mobility are associated with reduced disease transmission, and the expected time frame between behavioural changes and measurable population outcomes. [ABSTRACT FROM AUTHOR]

Next‐generation sequencing (NGS) is the primary method used to monitor the distribution and emergence of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) variants around the world; however, it is costly and time‐consuming to perform and is not widely available in low‐resourced geographical regions. Pyrosequencing has the potential to augment surveillance efforts by providing information on specific targeted mutations for rapid identification of circulating and emerging variants. The current study describes the development of a reverse transcription (RT)‐PCR‐pyrosequencing assay targeting >65 spike protein gene (S) mutations of SARS‐CoV‐2, which permits differentiation of commonly reported variants currently circulating in the United States with a high degree of confidence. Variants typed using the assay included B.1.1.7 (Alpha), B.1.1.529 (Omicron), B.1.351 (Beta), B.1.375, B.1.427/429 (Epsilon), B.1.525 (Eta), B.1.526.1 (Iota), B.1.617.1 (Kappa), B.1.617.2 (Delta), B.1.621 (Mu), P1 (Gamma), and B.1.1 variants, all of which were confirmed by the NGS data. An electronic typing tool was developed to aid in the identification of variants based on mutations detected by pyrosequencing. The assay could provide an important typing tool for rapid identification of candidate patients for monoclonal antibody therapies and a method to supplement SARS‐CoV‐2 surveillance efforts by identification of circulating variants and novel emerging lineages. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have found that severe acute respiratory syndrome (SARS) was associated with the physical and psychological stress of those infected. However, research is sparse regarding the long‐term health consequence of community SARS exposure for older adults. Methods: Using data from the 2011 and 2015 China Health and Retirement Longitudinal Study (CHARLS), we estimated multilevel regression models of allostatic load (AL) in the years after the SARS epidemic among 7735 respondents. Interaction terms between SARS epidemic exposure and social participation or community environment were included to examine potential effects. Results: We found that community SARS exposure was associated with greater AL for those who had no social participation. Among those who were in worse community environment, community SARS exposure was strongly related to elevated load in the cardiovascular system. However, for those had social participation and lived in better community environment, community SARS exposure manifested no association with AL years later. Active social participation and better community environment could offset the negative association between SARS exposure and AL. Conclusions: Taken together, these findings helped determine the positive direction of future social efforts and policy decisions to guide the global recovery from the devastating COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: Multiple factors have been identified as causes of intracranial compliance impairment (ICCI) among patients with obesity. On the other hand, obesity has been linked with worst outcomes in COVID‐19. Thus, the hypothesis of severe acute respiratory syndrome (SARS) conducing to cerebral hemodynamic disorders (CHD) able to worsen ICCI and play an additional role on prognosis determination for COVID‐19 among obese patients becomes suitable. Methods: 50 cases of SARS by COVID‐19 were evaluated, for the presence of ICCI and cerebrovascular circulatory disturbances in correspondence with whether unfavorable outcomes (death or impossibility for mechanical ventilation weaning [MVW]) within 7 days after evaluation. The objective was to observe whether obese patients (BMI ≥ 30) disclosed worse outcomes and tests results compared with lean subjects with same clinical background. Results: 23 (46%) patients among 50 had obesity. ICCI was verified in 18 (78%) obese, whereas in 13 (48%) of 27 non‐obese (p = 0,029). CHD were not significantly different between groups, despite being high prevalent in both. 69% unfavorable outcomes were observed among obese and 44% for lean subjects (p = 0,075). Conclusion: In the present study, intracranial compliance impairment was significantly more observed among obese subjects and may have contributed for SARS COVID‐19 worsen prognosis. [ABSTRACT FROM AUTHOR]

Background: Published reports on tocilizumab in COVID‐19 pneumonitis show conflicting results due to weak designs or heterogeneity in critical methodological issues. Methods: This open‐label trial, structured according to Simon's optimal design, aims to identify factors predicting which patients could benefit from anti‐IL6 strategies and to enhance the design of unequivocal and reliable future randomized trials. A total of 46 patients with COVID‐19 pneumonia needing of oxygen therapy to maintain SO2 > 93% and with recent worsening of lung function received a single infusion of tocilizumab. Clinical and biological markers were measured to test their predictive values. Primary end point was early and sustained clinical response. Results: Twenty‐one patients fulfilled pre‐defined response criteria. Lower levels of IL‐6 at 24 h after tocilizumab infusion (P = 0.049) and higher baseline values of PaO2/FiO2 (P = 0.008) predicted a favourable response. Conclusions: Objective clinical response rate overcame the pre‐defined threshold of 30%. Efficacy of tocilizumab to improve respiratory function in patients selected according to our inclusion criteria warrants investigations in randomized trials. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to investigate how the COVID‐19 pandemic has impacted reproductive medical providers' behaviors and considerations, including their concerns regarding the necessity of fertility treatments. Methods: A web‐based questionnaire was distributed to Japan Society of Fertilization and Implantation (JSFI) members from May 18 through May 31, 2020 to survey their professional behaviors and concerns during the COVID‐19 pandemic. Results: Most survey participants reported a decrease in the number of patients and a decrease in their workload. Most also believe that the use of fertility treatments will return to the pre‐pandemic levels after the COVID‐19 pandemic ends. Additionally, more than half of the participants reported that they consider fertility treatment neither necessary nor unnecessary during the COVID‐19 pandemic. Conclusions: At the institute where reproductive medical providers worked in Japan, the number of outpatients and the working time tended to decrease during the COVID‐19 pandemic. However, amid fears of infection during the COVID‐19 pandemic, the reproductive medical providers working at fertility institutes in Japan have remained engaged in their work with a sense of mission and hope. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID‐19) pandemic is a global health crisis. Very few studies have reported association between obesity and severity of COVID‐19. In this meta‐analysis, we assessed the association of obesity and outcomes in COVID‐19 hospitalized patients. Data from observational studies describing the obesity or body mass index and outcomes of COVID‐19 hospitalized patients from December 1, 2019, to August 15, 2020, was extracted following PRISMA guidelines with a consensus of two independent reviewers. Adverse outcomes defined as intensive care units, oxygen saturation less than 90%, invasive mechanical ventilation, severe disease, and in‐hospital mortality. The odds ratio (OR) and 95% confidence interval (95% CI) were obtained and forest plots were created using random‐effects models. A total of 10 studies with 10,233 confirmed COVID‐19 patients were included. The overall prevalence of obesity in our study was 33.9% (3473/10,233). In meta‐analysis, COVID‐19 patient with obesity had higher odds of poor outcomes compared with better outcomes with a pooled OR of 1.88 (95% CI: 1.25–2.80; p = 0.002), with 86% heterogeneity between studies (p < 0.00001). Our study suggests a significant association between obesity and COVID‐19 severity and poor outcomes. Our results findings may have important suggestions for the clinical management and future research of obesity and COVID‐19. [ABSTRACT FROM AUTHOR]

The pandemic of coronavirus disease 2019 (COVID‐19) is caused by infection with a novel coronavirus strain, the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). At present, there is limited information on potential transmission of the infection from mother to child, particularly through breast milk and breastfeeding. Here, we provide a living systematic review to capture information that might necessitate changes in the guidance on breast milk and breastfeeding given the uncertainty in this area. Our search retrieved 19,414 total records; 605 were considered for full‐text eligibility and no ongoing trials were identified. Our review includes 340 records, 37 with breast milk samples and 303 without. The 37 articles with analyzed breast milk samples reported on 77 mothers who were breastfeeding their children; among them, 19 of 77 children were confirmed COVID‐19 cases based on RT‐PCR assays, including 14 neonates and five older infants. Nine of the 68 analyzed breast milk samples from mothers with COVID‐19 were positive for SARS‐CoV‐2 RNA; of the exposed infants, four were positive and two were negative for COVID‐19. Currently, there is no evidence of SARS‐CoV‐2 transmission through breast milk. Studies are needed with longer follow‐up periods that collect data on infant feeding practices and on viral presence in breast milk. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) gains access to host cells by attaching to angiotensin‐converting enzyme 2 (ACE2). Vitamin D (VitD) can upregulate ACE2 and has an antagonistic effect on Renin, which exerts a vasodilatation and anti‐inflammatory effect against coronavirus disease (COVID‐19). However, it may also facilitate viral entry by increasing ACE2 as the main SARS‐CoV‐2 receptor and mediates ROS production through NADPH oxidase, as a double‐edged sword effect. Lung function and the immune system are also influenced by VitD through several mechanisms, including increased natural antibiotics (Defensin and Cathelicidin) and upregulated transforming growth factor‐β. A higher IgA, Th2/Th1 ratio, and T‐regulatory cells are attributable to VitD effects on the immune cells, while these changes may also be a double‐edged sword in COVID‐19. Although VitD supplementation might be highly recommended in COVID‐19, the administration's dosage and route could be challenging. Furthermore, this issue has not been mentioned in various studies so far. So, the report aimed to explain the current challenges with the application of VitD in COVID‐19. [ABSTRACT FROM AUTHOR]

Currently, the pandemic coronavirus disease 2019 (COVID‐19) has unprecedentedly captivated its human hosts by causing respiratory illnesses because of evolution of the genetic makeup of novel coronavirus (CoV) known as severe acute respiratory syndrome coronavirus‐2 (SARS CoV‐2). As much as the researchers are inundated for the quest of effective treatments from available drugs, the discovery and trials of new experimental drugs are also at a threshold for clinical trials. There has been much concern regarding the new and targeted drugs considering the comprehensive ambiguity regarding the mechanism and pathway of the drug action with respect to the new and unpredictable structural and nonstructural proteins (NSPs) of SARS CoV‐2. This study was aimed to discuss functional pathways related to NSPs in CoVs with updated knowledge regarding SARS CoV‐2, mechanisms of action of certain approved and investigational drugs for correct orientation regarding the treatment strategies, including nucleotide analog mechanism, receptor analog mechanism, and peptide–peptide interactions, along with the impact of COVID‐19 on a global scale. Although there is a dire need for targeted drugs against SARS CoV‐2, the practical achievement of its cure is possible by only using effective drugs with appropriate mechanisms to eliminate the disease. [ABSTRACT FROM AUTHOR]

Since its emergence in Wuhan as a novel coronavirus disease, it has taken only a few months since January 2020 for it to be recognized as a widespread COVID‐19 pandemic which has contributed to global health devastation. As pointed out by health experts, it is a once in a century pandemic of our times. Clinical observations so far indicate that the older population and immune compromised individuals, particularly in African American and Hispanic/Latino communities, are at much higher risk for infection with this novel coronavirus. In this regard, pregnancy offers an altered immunity scenario which may allow severe COVID‐19 disease. The literature is so far highly conflicting on this issue. This review will offer a conceptual basis for severe or controlled disease and address trepidations for pregnant women associated with COVID‐19 pandemic, particularly in the comparative context of clinical consequences of other coronaviruses such as SARS and MERS. We will highlight the possible consequences of COVID‐19 on the general health of pregnant women as well as its possible effects at the maternal‐fetal interface. For the placenta‐related pathology, we will focus our discussion on the temporal expression of ACE2 throughout gestation for possible propagation of SARS‐CoV‐2 in the placenta in infected women and ensuing consequences. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID‐19) represents a significant global medical issue, with a growing number of cumulative confirmed cases. However, a large number of patients with COVID‐19 have overcome the disease, meeting hospital discharge criteria, and are gradually returning to work and social life. Nonetheless, COVID‐19 may cause further downstream issues in these patients, such as due to possible reactivation of the virus, long‐term pulmonary defects, and posttraumatic stress disorder. In this study, we, therefore, queried relevant literature concerning severe acute respiratory syndrome, Middle East respiratory syndrome, and COVID‐19 for reference to come to a consensus on follow‐up strategies. We found that strategies, such as the implementation of polymerase chain reaction testing, imaging surveillance, and psychological assessments, starting at the time of discharge, were necessary for long‐term follow‐up. If close care is given to every aspect of coronavirus management, we expect that the pandemic outbreak will soon be overcome. Highlights: The follow‐up strategies should be well customized for the patients who met the discharge criteria of COVID‐19.The coronavirus shedding could maintain more than two weeks, and consecutive PCR should be mandatorily implemented.Mental health and quality of life perform a vital part of follow‐up tactics. [ABSTRACT FROM AUTHOR]

A hyperinflammatory response to severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) infection, reminiscent of cytokine release syndrome, has been implicated in the pathophysiology of acute respiratory distress syndrome and organ damage in patients with coronavirus disease 2019 (COVID‐19). Agents that inhibit components of the pro‐inflammatory cascade have garnered interest as potential treatment options with hopes that dampening the proinflammatory process may improve clinical outcomes. Baricitinib is a reversible Janus‐associated kinase (JAK)‐inhibitor that interrupts the signaling of multiple cytokines implicated in COVID‐19 immunopathology. It may also have antiviral effects by targeting host factors that viruses rely for cell entry and by suppressing type I interferon driven angiotensin‐converting‐enzyme‐2 upregulation. However, baricitinib's immunosuppressive effects may be detrimental during acute viral infections by delaying viral clearance and increasing vulnerability to secondary opportunistic infections. The lack of reliable biomarkers to monitor patients' immune status as illness evolves complicates deployment of immunosuppressive drugs like baricitinib. Furthermore, baricitinib carries the risk of increased thromboembolic events, which is concerning given the proclivity towards a hypercoagulable state in patients with COVID‐19. In this article, we review available data on baricitinib with an emphasis on immunosuppressive and antiviral pharmacology, pharmacokinetics, safety, and current progress in COVID‐19 clinical trials. [ABSTRACT FROM AUTHOR]

We analysed data from 80 patients who tested positive for SARS‐CoV‐2 RNA who had previously been HLA typed to support transplantation. Data were combined from two adjacent centres in Manchester and Leeds to achieve a sufficient number for early analysis. HLA frequencies observed were compared against two control populations: first, against published frequencies in a UK deceased donor population (n = 10,000) representing the target population of the virus, and second, using a cohort of individuals from the combined transplant waiting lists of both centres (n = 308), representing a comparator group of unaffected individuals of the same demographic. We report a significant HLA association with HLA‐ DQB1*06 (53% vs. 36%; p <.012; OR 1.96; 95% CI 1.94–3.22) and infection. A bias towards an increased representation of HLA‐A*26, HLA‐DRB1*15, HLA‐DRB1*10 and DRB1*11 was also noted but these were either only significant using the UK donor controls, or did not remain significant after correction for multiple tests. Likewise, HLA‐A*02, HLA‐B*44 and HLA‐C*05 may exert a protective effect, but these associations did not remain significant after correction for multiple tests. This is relevant information for the clinical management of patients in the setting of the current SARS‐CoV‐2 pandemic and potentially in risk‐assessing staff interactions with infected patients. [ABSTRACT FROM AUTHOR]

This article provides a review of studies evaluating the role of host (and viral) genetics (including variation in HLA genes) in the immune response to coronaviruses, as well as the clinical outcome of coronavirus‐mediated disease. The initial sections focus on seasonal coronaviruses, SARS‐CoV, and MERS‐CoV. We then examine the state of the knowledge regarding genetic polymorphisms and SARS‐CoV‐2 and COVID‐19. The article concludes by discussing research areas with current knowledge gaps and proposes several avenues for future scientific exploration in order to develop new insights into the immunology of SARS‐CoV‐2. [ABSTRACT FROM AUTHOR]

The global pandemic of novel coronavirus disease 2019 (COVID‐19) caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has created an urgent need for effective antivirals. Remdesivir (formerly GS‐5734) is a nucleoside analogue pro‐drug currently being evaluated in COVID‐19 clinical trials. Its unique structural features allow high concentrations of the active triphosphate metabolite to be delivered intracellularly and it evades proofreading to successfully inhibit viral RNA synthesis. In pre‐clinical models, remdesivir has demonstrated potent antiviral activity against diverse human and zoonotic β‐coronaviruses, including SARS‐CoV‐2. In this article, we critically review available data on remdesivir with an emphasis on biochemistry, pharmacology, pharmacokinetics, and in vitro activity against coronaviruses as well as clinical experience and current progress in COVID‐19 clinical trials. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study is to report our clinical experience in the management of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first 30 days of the coronavirus disease (COVID-19) pandemic.Material and Methods: We reviewed clinical data from the first 60 pregnant women with COVID-19 whose care was managed at Puerta de Hierro University Hospital, Madrid, Spain from 14 March to 14 April 2020. Demographic data, clinical findings, laboratory test results, imaging findings, treatment received, and outcomes were collected. An analysis of variance (Kruskal-Wallis test) was performed to compare the medians of laboratory parameters. Fisher's exact test was used to evaluate categorical variables. A correspondence analysis was used to explore associations between variables.Results: A total of 60 pregnant women were diagnosed with COVID-19. The most common symptoms were fever and cough (75.5% each) followed by dyspnea (37.8%). Forty-one women (68.6%) required hospital admission (18 because of disease worsening and 23 for delivery) of whom 21 women (35%) underwent pharmacological treatment, including hydroxychloroquine, antivirals, antibiotics, and tocilizumab. No renal or cardiac failures or maternal deaths were reported. Lymphopenia (50%), thrombocytopenia (25%), and elevated C-reactive protein (CRP) (59%) were observed in the early stages of the disease. Median CRP, D-dimer, and the neutrophil/lymphocyte ratio were elevated. High CRP and D-dimer levels were the parameters most frequently associated with severe pneumonia. The neutrophil/lymphocyte ratio was found to be the most sensitive marker for disease improvement (relative risk 6.65; 95% CI 4.1-5.9). During the study period, 18 of the women (78%) delivered vaginally. All newborns tested negative for SARS-CoV-2 and none of them were infected during breastfeeding. No SARS-CoV-2 was detected in placental tissue.Conclusions: Most of the pregnant women with COVID-19 had a favorable clinical course. However, one-third of them developed pneumonia, of whom 5% presented a critical clinical status. CRP and D-dimer levels positively correlated with severe pneumonia and the neutrophil/lymphocyte ratio decreased as the patients improved clinically. Seventy-eight percent of the women had a vaginal delivery. No vertical or horizontal transmissions were diagnosed in the neonates during labor or breastfeeding. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Within this large‐scale study, we compared clinical symptoms, laboratory findings, radiographic signs, and outcomes of COVID‐19, SARS, and MERS to find unique features. Method: We searched all relevant literature published up to February 28, 2020. Depending on the heterogeneity test, we used either random or fixed‐effect models to analyze the appropriateness of the pooled results. Study has been registered in the PROSPERO database (ID 176106). Result: Overall 114 articles included in this study; 52 251 COVID‐19 confirmed patients (20 studies), 10 037 SARS (51 studies), and 8139 MERS patients (43 studies) were included. The most common symptom was fever; COVID‐19 (85.6%, P <.001), SARS (96%, P <.001), and MERS (74%, P <.001), respectively. Analysis showed that 84% of Covid‐19 patients, 86% of SARS patients, and 74.7% of MERS patients had an abnormal chest X‐ray. The mortality rate in COVID‐19 (5.6%, P <.001) was lower than SARS (13%, P <.001) and MERS (35%, P <.001) between all confirmed patients. Conclusions: At the time of submission, the mortality rate in COVID‐19 confirmed cases is lower than in SARS‐ and MERS‐infected patients. Clinical outcomes and findings would be biased by reporting only confirmed cases, and this should be considered when interpreting the data. [ABSTRACT FROM AUTHOR]

Bats have long been observed to be the hosts and the origin of numerous human diseases. Bats, like all mammals, rely on a number of innate immune mechanisms to combat invading pathogens, including the interferon type I, II and III responses. Ubiquitin‐like interferon‐stimulated gene product 15 (ISG15) is a key modulator of these interferon responses. Within these pathways, ISG15 can serve to stabilize host proteins modulating innate immune responses and act as a cytokine. Post‐translational modifications of viral proteins introduced by ISG15 have also been observed to directly affect the function of numerous viral proteins. Unlike ubiquitin, which is virtually identical across all animals, comparison of ISG15s across species reveals that they are relatively divergent, with sequence identity dropping to as low as ∼58% among mammals. In addition to serving as an obstacle to the zoonotic transmission of influenza, these ISG15 species–species differences have also long been shown to have an impact on the function of viral deISGylases. Recently, the structure of the first nonhuman ISG15, originating from mouse, suggested that the structures of human ISG15 may not be reflective of other species. Here, the structure of ISG15 from the bat species Myotis davidii solved to 1.37 Å resolution is reported. Comparison of this ISG15 structure with those from human and mouse not only underscores the structural impact of ISG15 species–species differences, but also highlights a conserved hydrophobic motif formed between the two domains of ISG15. Using the papain‐like deISGylase from Severe acute respiratory syndrome coronavirus as a probe, the biochemical importance of this motif in ISG15–protein engagements was illuminated. The structure of interferon‐stimulated gene product 15 (ISG15) from the bat species M. davidii was elucidated to 1.37 Å resolution. Structural comparison of this ISG15 originating from a species of vesper bat endemic to China with those from mouse and human illuminates a conserved hydrophobic interface between the ubiquitin‐like domains of ISG15. The importance of this interaction was probed for its influence on ISG15 engagement by a papain‐like viral deISGylase using isothermal titration calorimetry. [ABSTRACT FROM AUTHOR]

ABSTRACT: Human coronaviruses (HCoVs) have been considered to be relatively harmless respiratory pathogens in the past. However, after the outbreak of the severe acute respiratory syndrome (SARS) and emergence of the Middle East respiratory syndrome (MERS), HCoVs have received worldwide attention as important pathogens in respiratory tract infection. This review focuses on the epidemiology, pathogenesis and clinical characteristics among SARS‐coronaviruses (CoV), MERS‐CoV and other HCoV infections. [ABSTRACT FROM AUTHOR]

The article offers information on the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) along with other severe respiratory viral infections. Topics discussed include SARS-coronavirus that first emerged in November, 2002 in Foshan, China, where many healthcare workers became infected; spread of the virus through respiratory droplets and contact with fomite; and the nosocomial transmission that was common during 2013–2016.

In addition, a cross-sectional study conducted on patients infected by COVID-19 [4] reported that patients, hospitalized and nonhospitalized, had psychological symptoms after an average of 50 days after diagnosis. Dear Editor, It was with great interest that we read the article "Short-term neuropsychiatric outcome and quality of life in COVID-19 survivors" by Méndez et al., which consisted on drawing an association between quality of life and neuropsychiatric effects resulting from the acute infection of COVID-19 [1]. Delirium and the need for intensive care cause Post-traumatic stress disorder (PTSD) in 20% of survivors in general [2]; these data are also proven by the analyzed article [1], as 25.1% tested positive for this condition. [Extracted from the article]

Background and Aims Mycoplasma pneumoniae (MP) is a common childhood pathogen associated with atypical pneumonia (AP). It is often a mild disease and seldom results in paediatric intensive care (PICU) admission. In 2003, World Health Organization (WHO) coined the word SARS (severe acute respiratory syndrome) in patients with severe acute respiratory symptoms (sars) for an outbreak of AP in Hong Kong due to a novel coronavirus. In 2012, another outbreak of coronavirus AP occurred in the Middle East. Confusing case definitions such as MERS (Middle East respiratory syndrome) and SARI (severe acute respiratory infections) were coined. This paper aims to present a case of MP with sars, ARDS, pneumonia and pleural effusion during the MERS epidemics, and review the incidence and mortality of severe AP with MP. Methods We presented a case of MP with sars, acute respiratory distress syndrome (ARDS), pneumonia and pleural effusion during the MERS epidemics, and performed a literature review on the incidence and mortality of severe AP with MP requiring PICU care. Results In early 2013, an 11-year-old girl presented with sars, ARDS (acute respiratory distress syndrome), right-sided pneumonia and pleural effusion. She was treated with multiple antibiotics. Streptococcus pneumoniae was not isolated in this girl with 'typical' pneumonia by symptomatology and chest radiography, but tracheal aspirate identified MP instead. The respiratory equations are computed with PaO2/FiO2 consistent with severe lung injury. Literature on the incidence and mortality of severe AP with MP requiring PICU care is reviewed. Six, 165 and 293 articles were found when PubMed (a service of the U.S. National Library of Medicine) was searched for the terms 'mycoplasma' and 'ICU', 'mycoplasma' and 'mortality', and 'mycoplasma' and 'severe'. Mortality and PICU admission associated with MP is general low and rarely reported. Experimental and clinical studies have suggested that the pathogenesis of lung injuries in MP infection is associated with a cell-mediated immune reaction, and high responsiveness to corticosteroid therapy has been reported especially for severe disease. Management of severe mycoplasma infection in the PICU includes general cardiopulmonary support and specific antimicrobial treatment. Macrolide resistance genotypes have been detected. Conclusion We urge health organizations to refrain from the temptation of coining unnecessary new terminology to describe essentially the same conditions each and every time when outbreaks of AP occur. [ABSTRACT FROM AUTHOR]

The article reports on the Severe acute respiratory syndrome (SARS) and selective inhibition of enzymatic activities with a thioxopyrimidine derivative for curing it. Topics discussed include helicase molecular proteins forming part of SARS and inhibitors developed against it like aryl diketoacids and dihydroxychromone derivatives; DTPMPA molecule developed for combating SARS effects; and experiment carried out on the same.

This review focuses on the important contributions that macromolecular crystallography has made over the past 12 years to elucidating structures and mechanisms of the essential proteases of coronaviruses, the main protease (Mpro) and the papain-like protease (PLpro). The role of X-ray crystallography in structure-assisted drug discovery against these targets is discussed. Aspects dealt with in this review include the emergence of the SARS coronavirus in 2002-2003 and of the MERS coronavirus 10 years later and the origins of these viruses. The crystal structure of the free SARS coronavirus Mpro and its dependence on pH is discussed, as are efforts to design inhibitors on the basis of these structures. The mechanism of maturation of the enzyme from the viral polyprotein is still a matter of debate. The crystal structure of the SARS coronavirus PLpro and its complex with ubiquitin is also discussed, as is its orthologue from MERS coronavirus. Efforts at predictive structure-based inhibitor development for bat coronavirus Mpros to increase the preparedness against zoonotic transmission to man are described as well. The paper closes with a brief discussion of structure-based discovery of antivirals in an academic setting. [ABSTRACT FROM AUTHOR]

The value of adjunctive immunomodulatory therapies in treating severe influenza and other respiratory viral infections remains uncertain. Although often used, systemic corticosteroids may increase the risk of mortality and morbidity (e.g. secondary infections) in severe influenza and other viral infections, especially if there is delay or lack of effective antiviral therapy. Non-randomized studies suggest that convalescent plasma appears useful as add-on therapy for patients with severe acute respiratory syndrome, avian influenza A( H5 N1), and influenza A ( H1 N1) 2009 pandemic [ A( H1 N1)pdm09), but it is limited by its availability. A recent randomized controlled trial ( RCT) comparing hyperimmune globulin prepared from convalescent plasma against normal intravenous gammaglobulin ( IVIG) manufactured before 2009 as control in patients with severe A( H1 N1)pdm09 infection on standard antiviral treatment has shown that the hyperimmune globulin group who received treatment within 5 days of symptom onset had a lower viral load and reduced mortality compared with the controls. A number of agents with immunomodulatory effects (e.g. acute use of statins, N-acetylcysteine, macrolides, PPAR agonists, IVIG, celecoxib, mesalazine) have been proposed for influenza management. However, more animal and detailed human observational studies and preferably RCTs controlling for the effects of antiviral therapy and disease severity are needed for evaluating these agents. The role of plasmapheresis and hemoperfusion as rescue therapy also merits more investigation. [ABSTRACT FROM AUTHOR]

SARS coronavirus (SARS-CoV) is the aetiological agent of the highly infectious severe acute respiratory syndrome (SARS). To gain a better understanding of SARS-CoV replication and transcription proteins, a preliminary X-ray crystallographic study of the C-terminal domain of SARS-CoV nonstructural protein 2 (nsp2) is reported here. The C-terminal domain of SARS-CoV nsp2 was cloned, overexpressed, purified and crystallized using polyethylene glycol 5000 monomethyl ether as the precipitant; the crystals diffracted to 2.5 Å resolution. The crystals belonged to space group P65, with unit-cell parameters a = b = 112.8, c = 91.1 Å, α = β = 90, γ = 120°. One molecule is assumed to be present per asymmetric unit, which gives a Matthews coefficient of 2.89 Å3 Da−1 and a solvent content of 56.2%. [ABSTRACT FROM AUTHOR]

Background and objective: Severe acute respiratory syndrome (SARS) emerged in 2003 and its long-term sequelae remain largely unclear. This study examined the long-term outcome of pulmonary function, exercise capacity, health and work status among SARS survivors. Methods: A prospective cohort study of SARS patients at the Prince of Wales Hospital, Hong Kong was conducted, with serial assessments of lung function, 6MWD and 36 item Short Form General Health Survey at 3, 6, 12, 18 and 24 months after disease onset. The work status was also recorded. Results: Serial assessments were completed by 55 of the 123 (39.9%) subjects, of whom 27 were health-care workers (HCW). The mean age of the group was 44.4 (SD 13.2) years and 19 (34.5%) were males. At 24 months, 10 (18.2%), 9 (16.4%), 6 (10.9%) and 29 (52.7%) subjects had FEV1, FVC, TLC and DLCO < 80% of predicted values, respectively. The mean (SD) 6MWD increased significantly from 439.0 (89.1) m at 3 months to 460.1 (102.8) m at 6 months ( P 0.016) and became steady after 6 months. However, 6MWD and 36 item Short Form General Health Survey scores were lower than the normal population throughout the study. Moreover, 29.6% of HCW and 7.1% of non-HCW had not returned to work 2 years after illness onset. Conclusions: This 2-year study of a selected population of SARS survivors, showed significant impairment of DLCO, exercise capacity and health status persisted, with a more marked adverse impact among HCW. [ABSTRACT FROM AUTHOR]

Aim. This study explored Taiwan’s nurse leaders’ reflections and experiences of the difficulties they encountered and survival strategies they employed fighting the severe acute respiratory syndrome epidemic and the background context framing these phenomena. Background. On several continents in 2002–2003, the highly infectious severe acute respiratory syndrome overwhelmed health care systems and health professionals who had to provide care in situations involving high personal risk and stress, some becoming infected and dying. Nurse leaders in Taiwan had to develop new strategies and support systems for nursing care. Design. A two-step within-method qualitative triangulation research design. Methods. Focus group in-depth interviews held with 70 nurse leaders from four Northern Taiwan hospitals involved in the severe acute respiratory syndrome epidemic. Participants then completed an open ended questionnaire. Content analysis was undertaken with data and stages and themes generated. Data were then analysed using Hobfall’s concepts of conservation of resources to further discuss participants’ reactions and actions in the severe acute respiratory syndrome crisis. Results. Participants worked under incredible stress to lead the profession through a period of crisis. Five stages arose in the participants’ involvement against severe acute respiratory syndrome over 12 weeks: facing shock and chaos; searching for reliable sources to clarify myths; developing and adjusting nursing care; supporting nurses and their clients; and rewarding nurses. Conclusion. Nurse leaders become important executors of intervention in this health disaster, requiring emotional intelligence to manage their internal conflicts and interpersonal relationships effectively. They developed sociopolitical and analytical abilities and crucial requirements for planning and implementing strategies in areas where none previously existed. Building support systems was an important resource for managing conflicts between familial and professional roles. Relevance to clinical practice. Findings will assist nurse leaders to prepare themselves and the profession to better deal with disaster management in similar infectious outbreaks in the future. [ABSTRACT FROM AUTHOR]

Objective To give an overview of the recent history of publications on mathematical modelling of infectious diseases in the Chinese literature, and a more detailed review of the models on severe acute respiratory syndrome (SARS). Method Literature review through the Chinese CAJ full-text database. Results The number of Chinese publications on mathematical modelling has at least quadrupled since the SARS epidemic in 2003. This increase not only included papers on SARS, but also on various other infectious diseases, indicating a substantial expansion of modelling experience in China. Typical problems of most studies were poor availability of data and lack of involvement of disease experts and decision-makers rendering the studies less useful for policies on control. Conclusions We expect that the recent experience on modelling and current better access to and exchange of epidemiological data have paved the way for a more substantial role of this discipline during possible future outbreaks of infectious diseases. By making Chinese modelling initiatives more visible to non-Chinese readers, we hope to attract more international collaborators. [ABSTRACT FROM AUTHOR]

Objective To document and verify the number of cases of severe acute respiratory syndrome (SARS) during the 2002–2003 epidemic in mainland China. Method All existing Chinese SARS data sources were integrated in one final database. This involved removing non-probable and duplicate cases, adding cases at the final stage of the outbreak, and collecting missing information. Results The resulting database contains a total of 5327 probable SARS cases, of whom 343 died, giving a case fatality ratio (CFR) of 6.4%. While the total number of cases happens to be equal to the original official reports, there are 5 cases overall which did not result in death. When compared with Hong Kong Special Administrative Region of China, China Taiwan, and Singapore, the SARS epidemic in mainland China resulted in a considerably lower CFR, involved relatively younger cases and included fewer health care workers. Conclusions To optimise future data collection during large-scale outbreaks of emerging or re-emerging infectious disease, China must further improve the infectious diseases reporting system, enhance collaboration between all levels of disease control, health departments, hospitals and institutes nationally and globally, and train specialized staff working at county centres of disease control. [ABSTRACT FROM AUTHOR]

Objective To summarise the major control measures implemented by severe acute respiratory syndrome (SARS)-affected countries and to compare distinctive features of the Chinese approach to other affected Asian countries and Canada. Method Literature review. Results The realisation in March 2003 that SARS was spreading led affected countries to introduce measures such as rapid dissemination of information, early case detection and isolation, tracing and quarantining of SARS contacts, traveller screening, raising public awareness of risk and institution of stricter infection control in health care settings. SARS became a notifiable disease in China in mid-April 2003, after which introduction of efficient nationwide control measures led to containment within 2 months. Countries differed in the timeliness of implementing control measures, the mode and extent to which these were enforced and in the resources available to do so. Conclusion SARS challenged the political and public health systems of all affected countries. It demanded rapid and decisive action to be taken, yet the comparison shows how difficult this was for an unknown new disease. Guangdong reacted rapidly but this pace was not continued by China for some time, which facilitated national and international spread. Once the Chinese government changed its policy, it developed an impressive control strategy involving the public which culminated in containment. The significance of timely information was perhaps the main lesson which the SARS epidemic taught. [ABSTRACT FROM AUTHOR]

Objective To analyse the case fatality ratio (CFR) and its risk factors for severe acute respiratory syndrome (SARS) in mainland China by using a comprehensive dataset of all probable cases. Methods The data of all probable SARS cases were derived from the Infectious Disease Reporting System of the Center of Diseases Control and Hospital Information Systems, during the 2003 epidemic in mainland China. The definition of probable SARS case was consistent with the definition for clinically confirmed SARS issued by the Ministry of Health of the People’s Republic of China. We performed univariate and multivariate logistic regression analysis to determine the association of CFR with age, sex, residence location, occupation, the period of the epidemic and the duration from symptom onset to admission into hospital. Results The overall CFR was 6.4% among 5327 probable SARS cases in mainland China. Old age, being a patient during the early period of a local outbreak, and being from Tianjin led to a relatively higher CFR than young age, late stage of a local outbreak and cases from Beijing. Guangdong Province resulted in an even lower CFR compared with Beijing. Conclusions Because of their deteriorated health status and apparent complications, SARS patients aged >60 years had a much higher risk of dying than younger patients. At the early stage of local outbreaks, lack of experience in patient care and perhaps treatment also led to a relatively higher CFR. The Tianjin SARS outbreak happened mainly within a hospital, leading to a high impact of co-morbidity. The relatively young age of the cases partly explains the low CFR in mainland China compared with other countries and areas affected by SARS. [ABSTRACT FROM AUTHOR]

Objectives To describe the spatiotemporal diffusion of the severe acute respiratory syndrome (SARS) epidemic in mainland China, and to analyse the spatial pattern of SARS transmission from the Beijing epicentre to its neighbouring areas. Methods Probable SARS cases occurring between November 2002 and May 2003 in mainland China were compiled from different sources and geo-coded into a geographical information database based on onset location. Spatial analyses including kernel density estimation, and spatial statistical and tracking analyses were performed to characterise the spatiotemporal distribution of SARS cases based on onset location/date. SARS cases that got infected in Beijing but were reported in three provinces surrounding Beijing were mapped, and logistic regression using a ‘case–control’ design at the county level was performed to analyse the impact of travel-related risk factors in the diffusion pattern. Results The SARS epidemic in mainland China spanned a large geographical extent but clustered in two areas: first in Guangdong Province, and about 3 months later in Beijing with its surrounding areas in Shanxi Province, Inner Mongolia Autonomic Region, Hebei Province and Tianjin. Counties in the neighbourhood of Beijing that were crossed by a national highway or inter-provincial freeway showed the highest risk of acquiring SARS infections, even after correction for population density and medical staff density. Being intersected by a railway did not significantly associate with risk of SARS. Conclusions This study provides the first complete documentation of the spatial and temporal characteristics of the SARS epidemic in mainland China. Our analyses confirmed that SARS had benefited from national highways and inter-provincial freeways for its spread from epicentres to neighbouring areas, whereas trains showed no significant association. This knowledge may be important for the control of re-emerging SARS, or other future emerging human-to-human transmittable infections. [ABSTRACT FROM AUTHOR]

Objective To describe and analyse factors associated with the duration of disease onset to hospital admission, admission to discharge and admission to death for severe acute respiratory syndrome (SARS), using the recently developed comprehensive database covering all regions of mainland China, and compare the results within and outside China. Methods The database included all probable 5327 SARS cases, of whom 343 died. Linear regression (uni- and multivariate analysis) was performed for all three durations to test the impact of the following variables: sex, age, occupation, geographic location and period of the SARS epidemic (time since the first case, i.e. 16 November 2002). Results The average duration of onset of symptoms to hospital admission was 3.8 days, of admission to discharge for those who survived was 29.7 days, while admission to death for casualties was 17.4 days. Health care workers, patients from Tianjin and patients infected towards the end of the epidemic had the shortest duration of onset to admission. Regarding admission to discharge, particularly young patients and patients from Guangdong had the shortest duration. Older age was the sole factor associated with shorter duration of admission to death. Conclusions The average duration and pattern (with time of epidemic and age) of onset of symptoms to hospital admission of SARS patients in mainland China were comparable to other affected areas. The duration of hospital admission to discharge was shorter than elsewhere, possibly because of different hospitalisation policies. The duration of hospital admission to death in mainland China, however, appeared to be shorter than in other areas, which is in striking contrast to the much lower case fatality in mainland China. [ABSTRACT FROM AUTHOR]

Objective To document the impact of the severe acute respiratory syndrome (SARS) outbreak in Beijing on indicators of social and economic activity. Methods Associations between time series of daily and monthly SARS cases and deaths and volume of public train, airplane and cargo transport, tourism, household consumption patterns and gross domestic product growth in Beijing were investigated using the cross-correlation function. Results Significant correlation coefficients were found for all indicators except wholesale accounts and expenditures on necessities, with the most significant correlations occurring with a delay of 1 day to 1 month. Conclusions Especially leisure activities, local and international transport and tourism were affected by SARS particularly in May 2003. Much of this consumption was merely postponed; but irrecoverable losses to the tourist sector alone were estimated at about US$ 1.4 bn, or 300 times the cost of treatment for SARS cases in Beijing. [ABSTRACT FROM AUTHOR]

Objectives To describe clinical characteristics of severe acute respiratory syndrome (SARS) patients in a hospital in Tianjin, China, thereby comparing probable and suspected cases; to study risk factors associated with the death of cases; to describe the implementation of preventive interventions during the hospital outbreak. Methods Physical and haematological information was obtained from clinical records. White blood cell counts, and percentages of neutrophilic granulocytes and neutrophilic lymphocytes were measured. The service department of the hospital provided information about daily use of protective materials. Differences in clinical symptoms between probable and suspected SARS cases were tested by Fisher’s exact test. Non-linear mixed modelling was used to test for differences between the haematological patterns for probable and suspected cases. Risk factors for dying among probable SARS cases were tested by logistic regression. Results The SARS outbreak started with a patient from Beijing on 15 April 2003, and spread quickly among the healthcare workers and in-patients in the hospital. In total 90 probable and 21 suspected cases were reported, with 17 deaths among them (case fatality rate 15%). Haematological patterns were significantly different between probable and suspected cases, whereas the percentages with certain clinical symptoms showed no apparent difference. Death of probable SARS cases was only significantly associated with high age and use of a respiratory machine (mainly for the most severe cases), whereas e.g. co-morbidity and steroid treatment showed no impact in multivariate analysis. Stringent control measures, including distribution of huge numbers of protective materials, started on 20 April, which soon lead to a strong decrease in the incidence of new cases. After the last SARS case left the hospital on 6 June, protective materials were dispensed at substantially lower rates, but not to zero, as was the case during the first days of the outbreak. Conclusion The working definition of probable SARS used during the epidemic appeared to have been fairly accurate. Many valuable lessons were learned regarding prevention of hospital spread of infection, especially the need to have sufficient protective supplies available and to implement these rigidly and at an early stage of an (threatening) epidemic. [ABSTRACT FROM AUTHOR]

Title. Nursing students’ knowledge and practice of infection control precautions: aneducational intervention. Aim. This paper is a report of the effectiveness of a purpose-designed education program in improving undergraduate nursing students’ understanding and practice of infection control precautions. Background. The severe acute respiratory syndrome outbreak in 2003 highlighted that healthcare workers were under-prepared for such an epidemic. While many in-service education sessions were arranged by institutions in response to the outbreak, preservice nursing education has overlooked preparation for handling such infectious disease epidemics. Method. A quasi-experimental design was used and a 16-hour, purpose-designed infection control education programme was implemented for preservice nursing students in southern Taiwan. Self-administered questionnaires were distributed at three time points during the period September 2005 to April 2006 to examine the sustainability and effectiveness of the intervention. Results. A total of 175 preservice nursing students participated in the study. Following the education programme, students in the intervention group showed a statistically significant improvement across time in their knowledge of these precautions [ F(2, 180) = 13·53, P < 0·001] and confidence in resolving infection-related issues [ F(1·79, 168·95) = 3·24] when compared with those in the control group. Conclusion. To improve nursing students’ capacity in responding to infectious epidemics, an educational programme that integrates the theme of infection precautions, learning theory and teaching strategies is recommended for all nursing institutes. [ABSTRACT FROM AUTHOR]

Nearly 75% of all emerging infectious diseases (EIDs) that impact or threaten human health are zoonotic. The majority have spilled from wildlife reservoirs, either directly to humans or via domestic animals. The emergence of many can be attributed to predisposing factors such as global travel, trade, agricultural expansion, deforestation/habitat fragmentation, and urbanization; such factors increase the interface and/or the rate of contact between human, domestic animal, and wildlife populations, thereby creating increased opportunities for spillover events to occur. Infectious disease emergence can be regarded as primarily an ecological process. The epidemiological investigation of EIDs associated with wildlife requires a trans-disciplinary approach that includes an understanding of the ecology of the wildlife species, and an understanding of human behaviours that increase risk of exposure. Investigations of the emergence of Nipah virus in Malaysia in 1999 and severe acute respiratory syndrome (SARS) in China in 2003 provide useful case studies. The emergence of Nipah virus was associated with the increased size and density of commercial pig farms and their encroachment into forested areas. The movement of pigs for sale and slaughter in turn led to the rapid spread of infection to southern peninsular Malaysia, where the high-density, largely urban pig populations facilitated transmission to humans. Identifying the factors associated with the emergence of SARS in southern China requires an understanding of the ecology of infection both in the natural reservoir and in secondary market reservoir species. A necessary extension of understanding the ecology of the reservoir is an understanding of the trade, and of the social and cultural context of wildlife consumption. Emerging infectious diseases originating from wildlife populations will continue to threaten public health. Mitigating and managing the risk requires an appreciation of the connectedness between human, livestock and wildlife health, and of the factors and processes that disrupt the balance. [ABSTRACT FROM AUTHOR]

Background Angiotensin converting enzyme 2 (ACE2), a monocarboxylase that degrades angiotensin II to angiotensin 1–7, is also the functional receptor for severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) and is highly expressed in the lungs and heart. Patients with SARS also suffered from cardiac disease including arrhythmias, sudden cardiac death, and systolic and diastolic dysfunction. Materials and methods We studied mice infected with the human strain of the SARS-CoV and encephalomyocarditis virus and examined ACE2 mRNA and protein expression. Autopsy heart samples from patients who succumbed to the SARS crisis in Toronto (Canada) were used to investigate the impact of SARS on myocardial structure, inflammation and ACE2 protein expression. Results Pulmonary infection with the human SARS-CoV in mice led to an ACE2-dependent myocardial infection with a marked decrease in ACE2 expression confirming a critical role of ACE2 in mediating SARS-CoV infection in the heart. The SARS-CoV viral RNA was detected in 35% (7/20) of autopsied human heart samples obtained from patients who succumbed to the SARS crisis during the Toronto SARS outbreak. Macrophage-specific staining showed a marked increase in macrophage infiltration with evidence of myocardial damage in patients who had SARS-CoV in their hearts. The presence of SARS-CoV in the heart was also associated with marked reductions in ACE2 protein expression. Conclusions Our data show that SARS-CoV can mediate myocardial inflammation and damage associated with down-regulation of myocardial ACE2 system, which may be responsible for the myocardial dysfunction and adverse cardiac outcomes in patients with SARS. [ABSTRACT FROM AUTHOR]

Asia is a highly heterogeneous region with vastly different cultures, social constitutions and populations affected by a wide spectrum of respiratory diseases caused by tropical pathogens. Asian patients with community-acquired pneumonia differ from their Western counterparts in microbiological aetiology, in particular the prominence of Gram-negative organisms, Mycobacterium tuberculosis, Burkholderia pseudomallei and Staphylococcus aureus. In addition, the differences in socioeconomic and health-care infrastructures limit the usefulness of Western management guidelines for pneumonia in Asia. The importance of emerging infectious diseases such as severe acute respiratory syndrome and avian influenza infection remain as close concerns for practising respirologists in Asia. Specific infections such as melioidosis, dengue haemorrhagic fever, scrub typhus, leptospirosis, salmonellosis, penicilliosis marneffei, malaria, amoebiasis, paragonimiasis, strongyloidiasis, gnathostomiasis, trinchinellosis, schistosomiasis and echinococcosis occur commonly in Asia and manifest with a prominent respiratory component. Pulmonary eosinophilia, endemic in parts of Asia, could occur with a wide range of tropical infections. Tropical eosinophilia is believed to be a hyper-sensitivity reaction to degenerating microfilariae trapped in the lungs. This article attempts to address the key respiratory issues in these respiratory infections unique to Asia and highlight the important diagnostic and management issues faced by practising respirologists. [ABSTRACT FROM AUTHOR]

To describe responses of Chinese elderly living in Edmonton, Canada, during the severe acute respiratory syndrome (SARS) pandemic, and their use of Western and/or traditional Chinese medicine. Design: A QUAL-qual mixed method design, using grounded theory as the core method and ethnographic strategies are used to inform the cultural aspects of the study. Sample: A purposeful sample of 19 Chinese elderly was interviewed and tape recorded. Four traditional Chinese Practitioners were also interviewed. Methods: The interviews were transcribed and analyzed in Chinese and later translated into English. Data analysis utilized the constant comparison method. Results: Participants experienced a 5-stage process of protecting self, family, and others, responding according to the perceived threat of SARS. Participants used both Western and traditional Chinese strategies to combat SARS. Their desire to protect others took precedence under the moral code of filial piety. Once SARS was under control, the community remained vigilant and continued to monitor for its possible reoccurrence. Conclusions: Cultural beliefs and practices within the Chinese population support the recommendations set by the health department for the protection of individuals and the community during the SARS pandemic. Therefore, the public health sector should become familiar with and support these Chinese cultural networks during pandemics. [ABSTRACT FROM AUTHOR]

This paper describes our studies on non-parametric maximum-likelihood estimators in a semiparametric mixture model for competing-risks data, in which proportional hazards models are specified for failure time models conditional on cause and a multinomial model is specified for the marginal distribution of cause conditional on covariates. We provide a verifiable identifiability condition and, based on it, establish an asymptotic profile likelihood theory for this model. We also provide efficient algorithms for the computation of the non-parametric maximum-likelihood estimate and its asymptotic variance. The success of this method is demonstrated in simulation studies and in the analysis of Taiwan severe acute respiratory syndrome data. [ABSTRACT FROM AUTHOR]

Virus-like particles (VLPs) represent a promising vaccine against severe acute respiratory syndrome coronavirus (SARS CoV). In this study, recombinant baculovirus vAcS and vAcME were constructed to express the S protein and the M and E proteins of SARS CoV, respectively. Electron microscope analysis demonstrated the formation of VLPs in vAcME and vAcS coinfected insect cells. Mice immunized four times with VLPs developed high antibody titres against SARS CoV. In addition, VLPs elicited cell-mediated immunity as demonstrated by enhanced interferon-γ and interleukin-4 production. VLPs also conferred protective immunity against the infection of Spike protein pseudotyped murine leukaemia virus. Our findings demonstrate that SARS CoV VLPs are immunogenic and can elicit strong SARS CoV-specific humoral and cellular immune responses in mice. This is the first study describing the immunogenicity of SARS CoV VLPs, providing valuable data for developing a protective vaccine against SARS CoV infection. [ABSTRACT FROM AUTHOR]

Background: The association between weather and severe acute respiratory syndrome (SARS) transmission in Beijing and Hong Kong in the 2003 epidemic was studied to examine the effect of weather on SARS transmission. Methods: Pearson’s correlation analyses and negative binomial regression analyses were used to quantify the correlations between the daily newly reported number of SARS cases and weather variables, using daily disease notification data and meteorological data from the two locations. Results: The results indicate that there were inverse association between the number of daily cases and maximum and/or minimum temperatures whereas air pressure was found to be positively associated with SARS transmission. Conclusion: The study suggests that weather might be a contributory factor in the 2003 SARS epidemic, in particular in the transmission among the community members. [ABSTRACT FROM AUTHOR]

Study Objectives. To distinguish adverse events related to ribavirin therapy from those attributable to severe acute respiratory syndrome (SARS), and to determine the rate of potential ribavirin-related adverse events. Design. Retrospective cohort study. Setting. Hospitals in Toronto, Ontario, Canada. Patients. A cohort of 306 patients with confirmed or probable SARS, 183 of whom received ribavirin and 123 of whom did not, between February 23, 2003, and July 1, 2003. Of the 183 treated patients, 155 (85%) received very high-dose ribavirin; the other 28 treated patients received lower-dose regimens. Measurements and Main Results. Data on all patients with SARS admitted to hospitals in Toronto were abstracted from charts and electronic databases onto a standardized form by trained research nurses. Logistic regression was used to evaluate the association between ribavirin use and each adverse event (progressive anemia, hypomagnesemia, hypocalcemia, bradycardia, transaminitis, and hyperamylasemia) after adjusting for SARS-related prognostic factors and corticosteroid use. In the primary logistic regression analysis, ribavirin use was strongly associated with anemia (odds ratio [OR] 3.0, 99% confidence interval [CI] 1.5-6.1, p<0.0001), hypomagnesemia (OR 21, 99% CI 5.8-73, p<0.0001), and bradycardia (OR 2.3, 99% CI 1.0-5.1, p=0.007). Hypocalcemia, transaminitis, and hyperamylasemia were not associated with ribavirin use. The risk of anemia, hypomagnesemia, and bradycardia attributable to ribavirin use was 27%, 45%, and 17%, respectively. Conclusions. High-dose ribavirin is associated with a high rate of adverse events. The use of high-dose ribavirin is appropriate only for the treatment of infectious diseases for which ribavirin has proven clinical efficacy, or in the context of a clinical trial. Ribavirin should not be used empirically for the treatment of viral syndromes of unknown origin. [ABSTRACT FROM AUTHOR]