Identify-Isolate-Inform: A Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department
First isolated in 1947 from a monkey in the Zika forest in Uganda, and from mosquitoes in the same forest the following year, Zika virus has gained international attention due to concerns for infection in pregnant women potentially causing fetal microcephaly. More than one million people have been infected since the appearance of the virus in Brazil in 2015. Approximately 80% of infected patients are asymptomatic. An association with microcephaly and other birth defects as well as Guillain-Barre Syndrome has led to a World Health Organization declaration of Zika virus as a Public Health Emergency of International Concern in February 2016. Zika virus is a vector-borne disease transmitted primarily by the Aedes aegypti mosquito. Male to female sexual transmission has been reported and there is potential for transmission via blood transfusions. After an incubation period of 2-7 days, symptomatic patients develop rapid onset fever, maculopapular rash, arthralgia, and conjunctivitis, often associated with headache and myalgias. Emergency department (ED) personnel must be prepared to address concerns from patients presenting with symptoms consistent with acute Zika virus infection, especially those who are pregnant or planning travel to Zika-endemic regions, as well as those women planning to become pregnant and their partners. The identify-isolate-inform (3I) tool, originally conceived for initial detection and management of Ebola virus disease patients in the ED, and later adjusted for measles and Middle East Respiratory Syndrome, can be adapted for real-time use for any emerging infectious disease. This paper reports a modification of the 3I tool for initial detection and management of patients under investigation for Zika virus. Following an assessment of epidemiologic risk, including travel to countries with mosquitoes that transmit Zika virus, patients are further investigated if clinically indicated. If after a rapid evaluation, Zika or other arthropod-borne diseases are the only concern, isolation (contact, droplet, airborne) is unnecessary. Zika is a reportable disease and thus appropriate health authorities must be notified. The modified 3I tool will facilitate rapid analysis and triggering of appropriate actions for patients presenting to the ED at risk for Zika.
Kristi L. Koenig, Abdulmajeed Almadhyan, Michael J. Burns
eScholarship Publishing, University of California
Medicine, Medical emergencies. Critical care. Intensive care. First aid
Efficacy Profile of the Homeopathic Combination for Influenza and Acute Respiratory Viral Diseases Treatment and Prevention
Homeopathic preparation, influenza, acute respiratory infections, Pharmacological properties
Background. Acute respiratory viral infection (ARVI) is accompanied by a general intoxication syndrome and respiratory mucosa predominant damage. A significant number of viral nature pathogens from various nosological groups (influenza viruses, parainfluenza, adenoviruses, respiratory syncytial viruses, coronaviruses, picornaviruses, rhinoviruses, enteroviruses, herpesviruses, etc.) could cause development of ARVI at human respiratory tract. Methods of ethnoscience and non-traditional medicine can be used as part of integrated treatment and prevention of influenza and ARVI. With the help of anti-cold homeopathic remedies, people can be treated from the very beginning of the disease when an elevated temperature is observed and there are all signs of intoxication and inflammation. Objective. Scientific justification for the safety and efficacy of a complex homeopathic formulation in tablet form (Aconitum napellus D6, Ammonium bromatum D4, Atropa belladonna D6, Bryonia D6, Cinchona pubescens D6, Echinacea D3, Hydrargyrum bicyanatum D8, Rhustoxicodendron D6) intended to enhance the natural immunity in influenza and respiratory diseases, to normalize the functional state of the immune system and upper respiratory tract. Results. Most patients have acute febrile respiratory syndrome, and some population groups have an increased risk of complications in the form of severe illness or death. These groups include elderly people, very young people, and people with concomitant illnesses. Annually, every third inhabitant of the planet suffers from acute respiratory infections. We have conducted a scientific substantiation of the safety and efficacy of a complex homeopathic tablet formulation (Aconitum napellus D6, Ammonium bromatum D4, Atropa belladonna D6, Bryonia D6, Cinchona pubescens D6, Echinacea D3, Hydrargyrum bicyanatum D8, Rhustoxico­dendron D6), which can be used to treat and prevention of these diseases. Conclusions. Components of developed homeopathic preparation are used in medical practice as anti-cold and immunomodulating mono- and complex homeopathic preparations for more than 100 years. There are no restrictions on the use of the drug in the context of its safety profile, since the active ingredient concentrations used are completely non-toxic. The preparation enhances the body’s protective responses and promotes the relief of symptoms of acute respiratory infections and flu (headache, sneezing, runny nose, sore throat, body aches, fever) and rapid recovery.
Larisa Bondarenko, Nadiia Gorchakova, Alexander Galkin
Innovative Biosystems and Bioengineering
National Technical University of Ukraine Igor Sikorsky Kyiv Polytechnic Institute""
Chemical and Biological Research on Herbal Medicines Rich in Xanthones
Herbal medicines, xanthones, Plant sources, Pharmacology, Gambogic acid, structure-activity relationships
Xanthones, as some of the most active components and widely distributed in various herb medicines, have drawn more and more attention in recent years. So far, 168 species of herbal plants belong to 58 genera, 24 families have been reported to contain xanthones. Among them, Calophyllum, Cratoxylum, Cudrania, Garcinia, Gentiana, Hypericum and Swertia genera are plant resources with great development prospect. This paper summarizes the plant resources, bioactivity and the structure-activity relationships (SARs) of xanthones from references published over the last few decades, which may be useful for new drug research and development on xanthones.
Jingya Ruan, Chang Zheng, Yanxia Liu, Lu Qu, Haiyang Yu, Lifeng Han, Yi Zhang, Tao Wang
Impact of Vitiation on a Swirl-Stabilized and Premixed Methane Flame
vitiation effects, LBO limits, CO emission, CO2 dilution, steam dilution
Vitiation refers to the condition where the oxygen concentration in the air is reduced due to the mix of dilution gas. The vitiation effects on a premixed methane flame were investigated on a swirl-stabilized gas turbine model combustor under atmospheric pressure. The main purpose is to analyze the combustion stability and CO emission performance in vitiated air and compare the results with the flame without vitiation. The N2, CO2, and H2O (steam) were used as the dilution gas. Measurements were conducted in a combustor inlet temperature of 384 K and 484 K. The equivalence ratio was varied from stoichiometric conditions to the LBO (Lean Blowout) limits where the flame was physically blown out from the combustor. The chemical kinetics calculation was performed with Chemkin software to analyze the vitiation effects on the flame reaction zone. Based on the calculation results, the changes in the temperature gradient, CO concentration, and active radicals across the flame reaction zone were identified. The time-averaged CH chemiluminescence images were recorded and the results indicated the features of the flame shape and location. The CH signal intensity provided the information about the heat-release zone in the combustor. The combustion LBO limits were measured and the vitiation of CO2 and H2O were found to have a stronger impact to elevate the LBO limits than N2. Near the LBO limits, the instability of the flame reaction was revealed by the high-speed chemiluminescence imaging and the results were analyzed by FFT (Fast Fourier Transfer). CO emission was measured with a water-cooled probe which is located at the exit of the combustor. The combustion vitiation has been found to have the compression effect on the operation range for low CO emission. However, this compression effect could be compensated by improving the combustor inlet temperature.
Mao Li, Yiheng Tong, Jens Klingmann, Marcus Thern
Probing the Effects of Pyrimidine Functional Group Switches on Acyclic Fleximer Analogues for Antiviral Activity
nucleoside, SAR, filovirus, Flavivirus, fleximers
Due to their ability to inhibit viral DNA or RNA replication, nucleoside analogues have been used for decades as potent antiviral therapeutics. However, one of the major limitations of nucleoside analogues is the development of antiviral resistance. In that regard, flexible nucleoside analogues known as “fleximers” have garnered attention over the years due to their ability to survey different amino acids in enzyme binding sites, thus overcoming the potential development of antiviral resistance. Acyclic fleximers have previously demonstrated antiviral activity against numerous viruses including Middle East Respiratory Syndrome coronavirus (MERS-CoV), Ebola virus (EBOV), and, most recently, flaviviruses such as Dengue (DENV) and Yellow Fever Virus (YFV). Due to these interesting results, a Structure Activity Relationship (SAR) study was pursued in order to analyze the effect of the pyrimidine functional group and acyl protecting group on antiviral activity, cytotoxicity, and conformation. The results of those studies are presented herein.
Mary K. Yates, Payel Chatterjee, Mike Flint, Yafet Arefeayne, Damjan Makuc, Janez Plavec, Christina F. Spiropoulou, Katherine L. Seley-Radtke
Development of Small-Molecule MERS-CoV Inhibitors
MERS-CoV, mechanism of action, Small molecule inhibitor
Middle East respiratory syndrome coronavirus (MERS-CoV) with potential to cause global pandemics remains a threat to the public health, security, and economy. In this review, we focus on advances in the research and development of small-molecule MERS-CoV inhibitors targeting different stages of the MERS-CoV life cycle, aiming to prevent or treat MERS-CoV infection.
Ruiying Liang, Li-li WANG, Naru Zhang, Xiaoqian Deng, Meng SU, Yudan Su, Lanfang Hu, Chen He, Tianlei Ying, Shibo Jiang, Fei Yu
SARS-Like Coronavirus WIV1-CoV Does Not Replicate in Egyptian Fruit Bats (Rousettus aegyptiacus)
WIV1-CoV, coronavirus, emerging infectious diseases, Animal model
Severe acute respiratory syndrome (SARS)-like WIV1-coronavirus (CoV) was first isolated from Rhinolophus sinicus bats and can use the human angiotensin converting enzyme 2 (ACE2) receptor. In the current study, we investigate the ability of WIV1-CoV to infect Rousettus aegyptiacus bats. No clinical signs were observed throughout the experiment. Furthermore, only four oropharyngeal swabs and two respiratory tissues, isolated on day 3 post inoculation, were found positive for viral RNA. Two out of twelve bats showed a modest increase in coronavirus specific antibodies post challenge. In conclusion, WIV1-CoV was unable to cause a robust infection in Rousettus aegyptiacus bats.
Neeltje van Doremalen, Alexandra Schäfer, Vineet D. Menachery, Michael Letko, Trenton Bushmaker, Robert J. Fischer, Dania M. Figueroa, Patrick W. Hanley, Greg Saturday, Ralph S. Baric, Vincent J. Munster
CD8+ T Cells Responding to the Middle East Respiratory Syndrome Coronavirus Nucleocapsid Protein Delivered by Vaccinia Virus MVA in Mice
MERS-CoV, MERS-CoV nucleocapsid protein, murine CD8+ T cell epitope, MVA vaccine
Middle East respiratory syndrome coronavirus (MERS-CoV), a novel infectious agent causing severe respiratory disease and death in humans, was first described in 2012. Antibodies directed against the MERS-CoV spike (S) protein are thought to play a major role in controlling MERS-CoV infection and in mediating vaccine-induced protective immunity. In contrast, relatively little is known about the role of T cell responses and the antigenic targets of MERS-CoV that are recognized by CD8+ T cells. In this study, the highly conserved MERS-CoV nucleocapsid (N) protein served as a target immunogen to elicit MERS-CoV-specific cellular immune responses. Modified Vaccinia virus Ankara (MVA), a safety-tested strain of vaccinia virus for preclinical and clinical vaccine research, was used for generating MVA-MERS-N expressing recombinant N protein. Overlapping peptides spanning the whole MERS-CoV N polypeptide were used to identify major histocompatibility complex class I/II-restricted T cell responses in BALB/c mice immunized with MVA-MERS-N. We have identified a H2-d restricted decamer peptide epitope in the MERS-N protein with CD8+ T cell antigenicity. The identification of this epitope, and the availability of the MVA-MERS-N candidate vaccine, will help to evaluate MERS-N-specific immune responses and the potential immune correlates of vaccine-mediated protection in the appropriate murine models of MERS-CoV infection.
Svenja Veit, Sylvia Jany, Robert Fux, Gerd Sutter, Asisa Volz
Strategy and technology to prevent hospital-acquired infections: Lessons from SARS, Ebola, and MERS in Asia and West Africa
SARS, Ebola, MERS, infection control, Hospital acquired infections, Strategy
Abstract Hospital-acquired infections (HAIs) are serious problems for healthcare systems, especially in developing countries where public health infrastructure and technology for infection preventions remain undeveloped. Here, we characterized how strategy and technology could be mobilized to improve the effectiveness of infection prevention and control in hospitals during the outbreaks of Ebola, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS) in Asia and West Africa. Published literature on the hospital-borne outbreaks of SARS, Ebola, and MERS in Asia and West Africa was comprehensively reviewed. The results showed that healthcare systems and hospital management in affected healthcare facilities had poor strategies and inadequate technologies and human resources for the prevention and control of HAIs, which led to increased morbidity, mortality, and unnecessary costs. We recommend that governments worldwide enforce disaster risk management, even when no outbreaks are imminent. Quarantine and ventilation functions should be taken into consideration in architectural design of hospitals and healthcare facilities. We also recommend that health authorities invest in training healthcare workers for disease outbreak response, as their preparedness is essential to reducing disaster risk.
Sanjeewa Jayachandra Rajakaruna, Wen-Bin Liu, Yi-Bo Ding, Guangwen Cao
Complications in critically ill adult patients’ transportations reported in the recent literature
severe acute respiratory syndrome, extracorporeal membrane oxygenation, transportation of patients, Mobile emergency unit
The transport of critically ill patients is a complex process, made up by several phases involving the healthcare professionals. It requires a careful planning for the prevention of potential complications undermining the patients’ safety outside critical care environment. Literature review about complications and adverse events reported during intra and inter-hospital transport of critically ill adult patients. Intra-hospital transfers are affected by adverse events rates ranging from 22.2 to 75.7% in the published literature. Major adverse events, defined as life threatening conditions that require urgent therapeutic intervention, vary from 4.2 to 31%. Death is a rare occurrence. Adverse events during interhospital have a maximum rate of 34%. Technical incidents represent a typical feature of these transports. Authors reported problems to gas supply, ambulance electric system, equipment. There is a lack of studies about the complications related to rotary wing inter-hospital transports. While extracorporeal membrane oxygenation/extracorporeal life support patients seem to be the most complex category of critically ill to be transported outside the hospital, 11 papers revealed only 29 adverse events ranging from 0 to 17%. No deaths were recorded. Currently, research must explore more accurately how much transports affect the outcome of patients, and what are the most appropriate time-frames to assess the consequences of transfers on patients’ clinical conditions.
Stefano Bambi, Alberto Lucchini, Diego Innocenti, Elisa Mattiussi