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SARS-CoV-2 pandemic is leading to an exponential growth of cases and the total number of confirmed cases has exceeded 3 million. Although respiratory droplets are the major route of transmission of the virus, but, Doremalen and colleagues in a recent study revealed that aerosol and fomites can be plausible routes of transmission. [1].

Abstract Purpose The first SARS-CoV-2 cases in Europe were reported in January 2020. Recently, concern arose on unrecognized infections before this date. For a better understanding of the pandemic, we retrospectively analyzed patient samples for SARS-CoV-2 from the prospective CAPNETZ study cohort. Methods We used nasopharyngeal swab samples from a cohort of well characterized patients with community acquired pneumonia of the CAPNETZ study group, recruited from different geographic regions across Germany, Austria, the Netherlands, and Switzerland between 02nd December 2019 and 28th April 2020. Multiplex real-time RT-PCR for a broad range of respiratory pathogens and SARS-CoV-2 real-time RT-PCR were performed on all samples. Results In our cohort, respiratory pathogens other than SARS-CoV-2 were detected in 21.5% (42/195) of patients with rhinovirus as the most frequently detected pathogen. The detection rate increased to 29.7% (58/195) when SARS-CoV-2 was included. No SARS-CoV-2 positive sample was detected before end of March 2020. Conclusions Respiratory viral pathogens accounted for a considerable number of positive results but no SARS-CoV-2 case was identified before the end of March 2020.…

Among carbapenem-sparing therapies, ceftolozane/tazobactam has been proposed for the treatment of infections due to CTX-M-15 producing Escherichia coli. However, few data exist on its in vivo activity in infections associated with a high bacterial inoculum.

Abstract Background After the introduction of a vaccine against B. pertussis the seasonal pattern with the highest number of infections in the spring to summer months changed. Recent studies from around the world suggest that B. pertussis infections again follow a seasonal pattern with increased incidence in summer.The aim of this study was to investigate whether respiratory infections caused by B. pertussis in the period from January 2008 to December 2018 also seasonally spread in Germany and if so, when the B. pertussis activity peaked. Methods We tested 19,031 samples, mainly from Southern Germany, collected in the period from January 2008 to December 2018 using a Multiplex PCR assay. We assessed the number and proportion of samples positive for B. pertussis, stratified by patient’s age and month. The seasonal distribution was investigated by plotting the average proportion of positive samples for each month. Results We observed a B. pertussis seasonality with the highest number of positive samples in the months from June until September. In contrast, testing of samples for B. pertussis was requested most frequently in the period from October until March. The proportion of positive samples increased earlier in adolescents (age 10 to 19) than in other age groups. Conclusions We found a seasonality of B. pertussis infections in Germany, which differs from the time when most samples are sent in for testing of B. pertussis. Our study suggests that clinicians should be more aware of B. pertussis infections in the months from June until September to prevent further transmission to vulnerable family members.…

Abstract Background People living with the Human Immunodeficiency Virus (PLHIV) have an increased susceptibility to develop non-communicable diseases such as cardiovascular disease (CVD). Infection with HIV contributes to the development of CVD independent of traditional risk factors, with endothelial dysfunction being the central physiological mechanism. While HIV-related mortality is declining due to antiretroviral treatment (ART), the number of deaths due to CVD is rising in South Africa - the country with the highest number of PLHIV and the world’s largest ART programme. The EndoAfrica study was developed to determine whether HIV infection and ART are associated with cardiovascular risk markers and changes in vascular structure and function over 18 months in adults from different provinces of South Africa. This paper describes the rationale, methodology and baseline cohort profile of the EndoAfrica study conducted in the North West Province, South Africa. Methods In this case-control study, conducted between August 2017 and June 2018, 382 volunteers of African descent (276 women; 106 men), comprising of 278 HIV infected and 104 HIV free individuals were included. We measured health behaviours, a detailed cardiovascular profile, and performed biomarker analyses. We compared baseline characteristics, blood pressure, vascular function and biochemical markers between those infected and HIV free. Results At baseline, the HIV infected participants were older (43 vs 39 years), less were employed (21% vs 40%), less had a tertiary education (7% vs 16%) and their body mass index was lower (26 vs 29 kg/m2) than that of the HIV free participants. While the cardiovascular profile, flow-mediated dilation and pulse wave velocity did not differ, glycated haemoglobin was lower (p = 0.017) and total cholesterol, high density lipoprotein cholesterol, triglycerides, gamma-glutamyltransferase and tobacco use were higher (all p 

Nature Medicine, Published online: 02 July 2020; doi:10.1038/s41591-020-0972-7Author Correction: Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017…

Although direct transmission in the hospitals cannot be ruled out, our data do not support widespread nosocomial transmission as the source of infection in patients or health-care workers.

In The Lancet Infectious Diseases, Dorothy Machalek and colleagues1 present a comprehensive systematic review and meta-analysis of genetic mutations in Mycoplasma genitalium that are associated with macrolide and fluoroquinolone resistance. Infection with M genitalium is now accepted as an important sexually transmitted infection (STI). Its prevalence in the general population is around 1% in high-income countries, and around 4% in low-income countries.2 The disease spectrum and symptoms caused by M genitalium are difficult to distinguish from those caused by Chlamydia trachomatis.

Global surveillance and measures to optimise the efficacy of treatments—including resistance-guided strategies, new antimicrobials, and antimicrobial combination approaches—are urgently needed to ensure cure in a high proportion of M genitalium infections and to prevent further spread of resistant strains.

World Zoonoses Day on July 6 marks the day, in 1885, when a young boy received the first vaccine against rabies—a zoonosis, a disease caused by a pathogen transmitted from animals to humans. Rarely is a World Zoonoses Day so relevant to consider these diseases and their disruption of societies.

Spontaneous pneumothorax is a pneumothorax that occurs in the absence of trauma or iatrogenic injury, and occurs in about 20 000 people per year in the USA.1 Primary spontaneous pneumothorax is typically defined as a pneumothorax that occurs in patients without evidence of underlying lung disease, and is estimated to affect about 3000 people per year in the UK,2 whereas secondary pneumothorax occurs in patients with known lung disease such as emphysema, lymphangioleiomyomatosis, or Birt-Hogg-Dubé syndrome.

Almost all men have some form of benign prostatic hyperplasia as they age, often resulting in lower urinary tract symptoms due to benign prostatic obstruction. Most patients with bothersome lower urinary tract symptoms are treated with drugs (eg, α blockers or 5α-reductase inhibitors) and surgery is usually reserved for patients who do not respond to drug treatment. Both the safety issues of medication and surgery-related morbidity must be weighed against the efficacy of these treatments. The main reasons for discontinuation of drug treatment are serious adverse effects, such as postural hypotension, asthenia, dizziness, and impairment of sexual function, or loss of efficacy over time.

Globally, poor access to high-quality surgical, obstetric, and anaesthesia care remains a main contributor to global disease burden accounting for about a third of deaths worldwide.1 The need for strengthening surgical care systems is especially urgent in sub-Saharan Africa, where access is strikingly limited, leading to the highest mortality and morbidity from surgically preventable and treatable conditions in the world.2,3 Approximately 93% of the population of sub-Saharan Africa lacks access to safe, affordable, and timely surgical care, compared with less than 10% in high-income countries.

Over the past decade, the global health community has begun to acknowledge that cancer is an increasingly important public health and economic challenge in all countries.1 What is not acknowledged is the disproportionate impact of cancer on the lives and livelihoods of women, and the downstream impacts this creates for societies. In 104 countries, breast cancer has the highest age-standardised incidence rate of all cancers in both sexes combined; in 23 countries, it is cervical cancer.2 Of the 938 044 deaths from these two cancers in 2018, most were premature and preventable and occurred in a low-income or middle-income countries (LMICs), where access to high-quality cancer control and care is limited and inequitable.

“I feel deeply the burden of the honour placed upon me in being chairman of this Medical Conference, which is unique in our history, powerful in its representation, and which gives China a strong position amongst nations seeking the welfare of the people”, wrote Wu Lien Teh in his first publication in The Lancet,1 on his inaugural address delivered at the International Plague Conference in Shenyang, China, in 1911. Wu was elected as the chair of the conference for his work in controlling the pneumonic plague epidemic outbreak in 1910–11 in northeastern China, which ultimately claimed about 60 000 lives.

A historic and calamitous milestone was reached this week. WHO reported more than 10 million cases of COVID-19 and over 500 000 COVID-19 deaths. The world's political leaders have been tested and they have been found wanting. It's hard to recall a more lamentable response to a global emergency. Even the climate crisis had its Kyoto and Paris agreements. But despite the urgency of this continuing human catastrophe, despite the immediacy of the economic collapse we are witnessing, there has still been no moment when nations have been convened to reflect on lessons to be learned, to coordinate actions to protect citizens, and to plan for future spikes or waves of infection.

Haiti lacks health programmes and facilities for kidney disease. Jane Regan reports on an ambitious collaboration between Haitian and US doctors to make kidney transplantation widely available.

As Associate Professor and Head of Global Surgery at the University of Cape Town (UCT), South Africa, Salome Maswime is aware of the scale of the job in front of her. “For me the big problem is the disconnect between health systems and clinical care in low and middle income countries, especially concerning surgical care. Outcomes are often poor, there being not enough focus on the quality of surgery, and how it relates to integrated health care and overarching health systems performance”, she explains.

Like many people, I use satnav when I'm driving to an unfamiliar address. I know that if I follow the instructions as they come up, I'll almost certainly get to my destination. But there are times when you need a broader sense of the territory you'll be passing through. If you're plotting a route from one part of the country to another in the car, a small-scale road atlas works well. If you're planning a cross-country hike, however, you'll need a map that shows the landscape in detail—contours, footpaths, points of reference.

At the opening plenary of the World Health Assembly in May, 2019, Richard Horton urged member states and the Secretariat of WHO to recognise climate change as a planetary emergency. A few days later, during a side event on air pollution, climate change, oceans, and health sponsored by the Government of Sweden, the Minister of Health for the Seychelles Jean Paul Adam argued that climate change has to be recognised as a public health emergency at the international level. Johan Giesecke1 once stressed that as public health emergencies of international concern (PHEICs) evolve into more complex forms, it becomes necessary to identify gaps in the alarm and response mechanism of the International Health Regulations (IHRs).

The Trump administration issued the Protecting Life in Global Health Assistance policy in 2017. This policy is an expansion of the Global Gag Rule that blocks US global health assistance to foreign non-governmental organisations that provide, counsel on, refer to, or advocate for abortion services; even if they do so with their own funding and in countries where abortion is legal. Following an additional policy expansion in 2019, foreign organisations that comply with the policy must now attach it to all subgrants that they give to other foreign organisations, including those that do not involve US global health assistance.

We found the Article by Maigeng Zhou and colleagues1 intriguing. However, we have some concerns. Our major concern arises from mixing data from mainland China and Taiwan. These two regions have distinct health-care and social welfare systems; they also have different time trends of how socioeconomic conditions evolved during the past half century. Therefore, mixing the data from these two regions might lead to biased estimates, especially for the health outcomes shaped by health policies (eg, vaccination programmes as a prevention strategy).

The Global Burden of Disease Study (GBD) 2017 provides comprehensive assessment of population health for 195 countries and territories and subnational units for selected countries, including all province-level administrative units in China. It is important to point out that, as the GBD uses a hierarchical analytical framework, data input from all GBD 2017 analytical units, national or subnational, are integrated into a single modelling process to provide a set of estimates for all locations that are internally consistent and comparable across locations and over time.

Ambulatory management of primary spontaneous pneumothorax significantly reduced the duration of hospitalisation including re-admissions in the first 30 days, but at the expense of increased adverse events. This data suggests that primary spontaneous pneumothorax can be managed for outpatients, using ambulatory devices in those who require intervention.

TURP and ThuVARP were equivalent for urinary symptom improvement (IPSS) 12-months post-surgery, and TURP was superior for Qmax. Anticipated laser benefits for ThuVARP of reduced hospital stay and complications were not observed.

A 24-week pregnant 18-year-old woman was seen at her local health-care centre where she was found to have a respiratory rate of 38 breaths per min, a blood pressure of 250/90 mm Hg, and a heart rate of 39 beats per min. She collapsed and required intubation and ventilation. A chest x-ray showed bilateral infiltrates—pulmonary oedema—and she was treated with furosemide and nitroglycerin and transferred to our intensive care unit.

Uromodulin is the most abundant protein in human urine and forms filaments that antagonize the adhesion of uropathogens; however, filament structure and mechanism of protection remain poorly understood. We used cryo-electron tomography to show that the uromodulin filament consists of a zigzag-shaped backbone with laterally protruding arms. N-glycosylation mapping and biophysical assays revealed that uromodulin acts as a multivalent ligand for the bacterial type 1 pilus adhesin, presenting specific epitopes on the regularly spaced arms. Imaging of uromodulin-uropathogen interactions in vitro and in patient urine showed that uromodulin filaments associate with uropathogens and mediate bacterial aggregation, which likely prevents adhesion and allows clearance by micturition. These results provide a framework for understanding uromodulin in urinary tract infections and in its more enigmatic roles in physiology and disease.…

Catalyzing water dissociation (WD) into protons and hydroxide ions is important both for fabricating bipolar membranes (BPMs) that can couple different pH environments into a single electrochemical device, and for accelerating electrocatalytic reactions that consume protons in neutral-to-alkaline media. We designed a BPM electrolyzer to quantitatively measure WD kinetics and show that, for metal nanoparticles, WD activity correlates with alkaline hydrogen-evolution-reaction activity. By combining metal-oxide WD catalysts efficient near the acidic proton-exchange layer with those efficient near the alkaline hydroxide-exchange layer, we demonstrate a BPM driving WD with overpotentials of < 10 mV at 20 mA·cm–2 and pure-water BPM electrolyzers that operate with an alkaline anode and acidic cathode at 500 mA·cm–2 with a total electrolysis voltage of ~ 2.2 V.…

Coronavirus disease 2019 (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic. It currently remains unclear whether convalescing patients have a risk of reinfection. We generated a rhesus macaque model of SARS-CoV-2 infection that was characterized by interstitial pneumonia and systemic viral dissemination mainly in the respiratory and gastrointestinal tracts. Rhesus macaques reinfected with the identical SARS-CoV-2 strain during the early recovery phase of the initial SARS-CoV-2 infection did not show detectable viral dissemination, clinical manifestations of viral disease, or histopathological changes. Comparing the humoral and cellular immunity between primary infection and rechallenge revealed notably enhanced neutralizing antibody and immune responses. Our results suggest that primary SARS-CoV-2 exposure protects against subsequent reinfection in rhesus macaques.…

Versatile chemical transformations of surface functional groups in 2D transition-metal carbides (MXenes) open up a new design space for this broad class of functional materials. We introduce a general strategy to install and remove surface groups by performing substitution and elimination reactions in molten inorganic salts. Successful synthesis of MXenes with O, NH, S, Cl, Se, Br, and Te surface terminations, as well as bare MXenes (no surface termination) was demonstrated. These MXenes show distinctive structural and electronic properties. For example, the surface groups control interatomic distances in the MXene lattice, and Tin+1Cn (n = 1, 2) MXenes terminated with Te2– ligands show a giant, (>18%) in-plane lattice expansion compared to the bulk TiC lattice. Nb2C MXenes exhibited surface-group-dependent superconductivity.…

Discovery of robust yet reversibly switchable electric dipoles at reduced dimensions is critical in advancing nanoelectronics devices. Energy bands flat in momentum space generate robust localized states that are activated independently of each other. We determined flat bands exist and induce robust yet independently switchable dipoles exhibiting a unique ferroelectricity in HfO2. Flat polar phonon bands in HfO2 cause extreme localization of electric dipoles within its irreducible half-unit-cell-widths (~3 Å). Contrary to conventional ferroelectrics with spread dipoles, those intrinsically localized dipoles are stable against extrinsic effects such as domain walls, surface exposure, and even down-to-angstrom-scale miniaturization. Moreover, the sub-nm-scale dipoles are individually switchable without creating any domain-wall energy cost. This offers unexpected opportunities for ultimately-dense unit-cell-by-unit-cell ferroelectric switching devices directly integrable into silicon technology.…

In the perspective, Beldomenico hypothesizes that the variability in the global incidence of covid-19 may be explained by the presence of superspreaders. Briefly, Covid-19 “spreads gradually within a region” until a superspreader emerges (or is imported). Next, superspreaders not only cause a large number of transmissions, those infected by a superspreader are more likely to be superspreaders. While this hypothesis is interesting, I argue it is extremely unlikely to be relevant in explaining Covid-19 dynamics.

I his comment, Almogy (2020) claims there is no evidence of superpsreaders-begat-superspreaders. To date, this is true, but there is also a lack of data that contradicts that possibility. Almogy goes further asserting that superspreaders are not playing an important role in the pandemic, basing his contention on the 'latest available data'. However, he does not provide relevant references of such data.

It can be said that SARS-CoV-2 caught the world by surprise. In large part due to globalization, the virus quickly evolved from a serious regional concern to a worldwide pandemic, the likes of which are unprecedented in the last century. In a matter of weeks, COVID-19 became a leading cause of death, with a potential staggering death toll in 2020. Due to a heavy burden of illness, and in the absence of proven therapies, several experimental treatments have been and continue to be prescribed outside of clinical trial settings.

D. Bugembe et al.

Most coronavirus disease 2019 (COVID-19) cases were identified as moderate, which is defined as having a fever or dry cough and lung imaging with ground-glass opacities. The risk factors and predictors of prognosis in such cohorts remain uncertain.

Healthcare-associated respiratory viral infections (RVI) remain an underappreciated cause of in-hospital morbidity and mortality.[1] Infection prevention bundles comprising segregation of symptomatic patients, droplet/contact precautions and visitor screening can potentially reduce the transmission of RVI on high-risk units, [2] though hospital-wide implementation has been limited. The current COVID-19 pandemic highlights the importance of strengthening hospital-wide infection control against common RVI.

Tropical Medicine & International Health, EarlyView.

Tropical Medicine & International Health, EarlyView.

Tropical Medicine & International Health, Accepted Article.

AbstractBackgroundNorovirus is a leading cause of acute gastroenteritis. With vaccines in development, population-based estimates of norovirus burden are needed to identify target populations, quantify potential benefits, and understand disease dynamics.MethodsWe estimated the attributable fraction (AF) for norovirus infections in children, defined as the proportion of children testing positive for norovirus whose gastroenteritis was attributable to norovirus. We calculated the standardized incidence and emergency department (ED) visit rates attributable to norovirus using provincial gastroenteritis visit administrative data.ResultsFrom 3,731 gastroenteritis cases and 2,135 controls we determined the AF was 67.0% (95% CI 31.5%, 100%) and 91.6% (95% CI 88.8%, 94.4%) for norovirus genogroups I (GI) and II (GII), respectively. Norovirus GII AF varied by season but not age. We attributed 116 (95% CI 103, 129) episodes and 59 (95% CI 51, 67) ED visits per 10,000 child-years to norovirus GII across all ages, accounting for 20% and 18% of all medically attended gastroenteritis episodes and ED visits, respectively.ConclusionsIn children, a large proportion of norovirus GII detections reflect causation, demonstrating significant potential for norovirus GII vaccines. Seasonal variation in the norovirus GII AF may have implications for understanding the role asymptomatic carriage plays in disease dynamics.

M. Feaster and Y. Goh…

Abstract Background Carbapenem-resistant hypervirulent Klebsiella pneumoniae strains have recently come into existence worldwide; however, researchers in northeast China are not aware of their clinical features and molecular characteristics. Methods Here, the molecular and virulent characteristics of 44 carbapenem-resistant K. pneumoniae (CRKP) isolates collected from January 2015 to December 2017 were studied. Multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) were carried out to define the clonal relatedness among the isolates. PCR and capsular serotyping of the virulence-associated genes, as well as biofilm formation and serum complement-mediated killing assays, were employed to determine the virulent potential. The genomic features and associated mobile genetic elements of JmsCRE57 were detected by whole genome sequencing. Results The only positive isolate was JmsCRE57, which belonged to the ST375 serotype K2 that expressed uge, mrkD, fimH, kpn, aerobactin and rmpA virulence-associated genes and showed strong biofilm formation and serum sensitivity. Sequencing results showed that the JmsCRE57 genome mainly consisted of a circular chromosome, three antimicrobial resistant plasmids and a virulent plasmid. The antimicrobial resistant plasmid expressing blaKPC-2, blaCTX-M-15, aph(3″)-Ib, aph(6)-Id, qnrB1, aac(3)-IIa, aac(6′)-Ib-cr, blaOXA-1, blaTEM-1B, catB4, sul2, dfrA14 and blaSHV-99. The virulent plasmid belonged to the IncHI1B group, which is mainly composed of mucoid phenotype genes and siderophore-associated genes. The remaining CRKP strains that expressed uge, fimH, mrkD and kpn virulence-associated genes were not successfully typed. Conclusion Our results provide new insights on the epidemiology of carbapenem-resistant K2 hypervirulent K. pneumoniae ST375 and CRKP ST76 strains in northeast China, which may help control their future outbreaks.…

Adenovirus (AdV) is a nonenveloped viruses with an icosahedral nucleocapsid containing a double stranded DNA genome (Lynch et al., 2011). It is one of the most common pathogens obligated for respiratory infections in immunocompetent adults and elderly individuals (Hakim and Tleyjeh, 2008; Tan et al., 2016; Lynch and Kajon, 2016). Meanwhile, respiratory viruses, which account for a proportion of more than 22%, are detected more frequently than bacteria in adults with acute respiratory disease (ARD) (Jain et al., 2015; Ruuskanen et al., 2011).

The novel Severe Acute Respiratory Syndrome associated beta-coronavirus (SARS-CoV-2) of unknown origin, appeared in Wuhan, China in late December 2019 and has swept the world over the past few months (Anderson et al. 2020; Li et al. 2020a; Zhu et al. 2020), causing over 491,500 deaths worldwide (https://coronavirus.jhu.edu/map.html, accessed on June 26, 2020) and significantly disrupting both societal activities and person life(Center 2020). Although several early studies described the dynamics of the epidemic process in details (Li et al.

As of May 27, 2020, there were over 1,678,843 confirmed cases of COVID-19 claiming more than 100,000 lives in the Unites States. (Cases in the U.S, 2020) Currently there is no known effective therapy or vaccine. The urgent need for therapeutic agents has resulted in repurposing and redeployment of experimental agents (McCreary and Pogue, 2020; Sanders et al., 2020).

Infectious diseases impose a major health threat globally, leading to 15 million deaths annually (Fauci et al., 2005). Although the percentage of mortality due to infectious diseases has declined, numerous new infectious diseases have been identified and reported recently. The novel coronavirus disease (COVID-19), caused by the SARS-CoV-2 virus, was firstly identified in Wuhan, China, in late December 2019 as an outbreak of unusual viral pneumonia (Mousavizadeh and Ghasemi, 2020). Later, the World Health Organization (WHO) declared a public health emergency worldwide, and the total number of infected cases reached 4.4 million by May 2020 (WHO, 2020).

Paradoxical Tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS) is the apparent clinical or radiological deterioration seen in pre-existing lesions or emergence of new lesions of Tuberculosis (TB) after Anti-Retroviral Therapy (ART) initiation among HIV-TB coinfected patients, despite temporary improvement with anti-TB treatment (ATT) and effective virological suppression (Gopalan et al., 2014, Lawn et al., 2005, Lawn et al., 2007). The dynamics of this phenomenon that frequents concomitant therapy especially in the scenario of advanced HIV and early ART initiation, is explained by the cytokine storm that gets unleashed with ART (Bourgarit et al., 2006, Tadokera et al., 2011).

Human gemykibivirus 2 (HuGkV-2) is a member of the Genomoviridae family. The representatives of this family are small viral agents (20-22 nm) with circular DNA genome (∼2 kb). They are largely distributed in the environment and infect wide variety of hosts including fungi, plants, insects, different animals and humans (Krupovic et al., 2016).

In recent years, digitalization and artificial intelligence made tremendous progress. In medicine, data-driven technologies are especially applicable in areas with a high degree of automation and standardization of data1,2. Substantial advances have as well been reported in clinical microbiology, but translation into routine application remains a long process with several technical and regulatory hurdles. Some of the low hanging fruits for diagnostics scenarios include (i) dashboards to interconnect and visualize microbiology data3,4, (ii) automated analysis of images such as microscopy slides5 or agar plates6,7, and (iii) association of genome sequences and proteomic profiles with pathogen phenotypes8,9.