Physical/social distancing, handwashing, respiratory hygiene, and face-masking have been recommended as realistic counterstrategies to control the COVID-19 pandemic. These strategies have been critical in the fight against the present pandemic in many countries. Here, we detail the background to such countermeasures, present some examples in different settings, and finally emphasize that they should remain in place worldwide as a cultural and behavioral “new normal” until a vaccine or a decisive treatment for COVID-19 is developed and made available globally.

The emergence of new type of viral pneumonia cases in China, on December 31, 2019; identified as the cause of human coronavirus, labeled as “COVID-19,” took a heavy toll of death and reported cases of infected people all over the world, with the potential to spread widely and rapidly, achieved worldwide prominence but arose without the procurement guidance. There is an immediate need for active intervention and fast drug discovery against the 2019-nCoV outbreak. Herein, the study provides numerous candidates of drugs (either alone or integrated with another drugs) which could prove to be effective against 2019-nCoV, are under different stages of clinical trials. This review will offer rapid identification of a number of repurposable drugs and potential drug combinations targeting 2019-nCoV and preferentially allow the international research community to evaluate the findings, to validate the efficacy of the proposed drugs in prospective trials and to lead potential clinical practices.

Background and Purpose: Tetanus neurotoxin has many potential therapeutic applications, due to its ability to increase localised muscle tone when injected directly into a muscle. It is a closely related molecule to botulinum neurotoxin (most commonly known as Botox), which has been widely used to release muscle tension for therapeutic and cosmetic applications. However, tetanus toxin has been relegated to the “maybe pile” for protein therapeutics — as most of the population is vaccinated, leading to highly effective antibody-mediated protection against the toxin. The potential for tetanus-based therapeutics remains substantial if the problem of pre-existing immunity can be resolved. Experimental Approach: A well-established murine model of localised muscular contraction was utilised. We administered functional tetanus toxin combined with an immunogenic, but functionally inactive, decoy molecule. Key Results: Incorporation of the decoy molecule greatly reduces the dose of active toxin required to induce a localised increase in muscle tone in mice vaccinated with the human toxoid vaccine. Conclusion and Implications: Our results clearly demonstrate that the barriers to developing a tetanus toxin therapeutic are not insurmountable and the technology presented here is the first major step towards realising the therapeutic potential of this powerful neurotoxin. Opening the therapeutic potential of tetanus toxin will have huge implication for the wide range of diseases caused by low-tone muscle.

Abstract: The number of infected cases with COVID-19 increase gradually, and some of the COVID-19 patients present with concomitant cardiovascular problems that might require surgical intervention. However, we do not have sufficient evidence of optimum timing for cardiac surgery in patients with COVID-19 whose surgery cannot be postponed or who cannot be treated percutaneously. Here we discuss the management of a patient that diagnosed with COVID-19 and required urgent cardiac surgery for symptomatic moderate aortic and severe mitral valve regurgitation.

A 6.5-month-old girl presented to a pediatrician for a second opinion regarding worsening macrocephaly and developmental regression. She then underwent neurosurgical evaluation. Rapid-sequence magnetic resonance imaging was significant for benign enlargement of the subarachnoid space of infancy. A complete blood count was significant for 33% blasts in the peripheral blood. Flow cytometry of the peripheral blood established a diagnosis of T-cell Acute Lymphoblastic Leukemia (ALL). T-cell ALL has been rarely reported and our patient’s presentation with macrocephaly is particularly unique.

Objective To explore patients’ attitudes and acceptability of universal screening for COVID-19 in a maternity population. Design Pre-screening and post-screening patient surveys Setting London Population Women admitted to the Maternity Unit at Newham Hospital during a two-week trial period of universal screening. Methods Cluster random sampling was used to select participants to complete the pre-screening questionnaire. Post-screening questionnaires were performed over the telephone. Main outcome measured Agreement to statements regarding patient’s acceptability of the SARS-CoV-2 screening test and the impact screening had on the care provided to themselves and their babies. Results During the two-week period, 180 women underwent universal screening. 81 participants completed the pre-screening questionnaire and 79 participants completed the post-screening survey (72-85% completion rate). More than 70% of women agreed that routine screening resulted in a positive effect on their care, the care of their babies and on their families. More than 80% of women agreed that they would be happy with their care if all pregnant women were offered testing for COVID-19 on admission to hospital. However, 50.62% of women agreed that having a COVID-19 screening swab test taken was uncomfortable and 35.80% were worried about the test results. Nulliparous women were more likely to perceive the positive impacts of screening on their care, their babies care, and their families as compared to multiparous women. Conclusion Our study provides evidence that patient acceptability and tolerance to COVID-19 screening is high, which is key for future implementation of universal screening across maternity services in the UK.

COVID-19: The heart of the issue Beth Woodward BMedSc (Hons)1, Muhammed Kermali2College of Medical and Dental Sciences, University of Birmingham, Birmingham, UKSt. George’s, University of London, London, UKCorresponding author:Beth WoodwardBMedSc (Hons)College of Medical and Dental SciencesUniversity of BirminghamBirmingham, UKe-mail: blw472@student.bham.ac.ukTel: 07947766140Funding: none obtainedConflict of Interest: none to be declaredKey words: COVID-19, angiotensin, ACEiBW and MK contributed equally.

Background: Sickle cell anemia is an autosomal recessive inherited disorder that affects approximately 5% of the world population. These patients are at greater risk for developing Hodgkin’s lymphoma. Cardiopulmonary bypass can trigger lethal vaso-occlusive crises in those patients if they are subjected to hypoxia, hypothermia, acidosis, or low-flow states. Case presentation: This case report describes a patient with sickle cell anemia and history of stroke was diagnosed with Bicuspid aortic valve stenosis and aneurysmal dilatation of the ascending aorta complicated with infective endocarditis. During routine workup he was discovered to have Hodgkin’s Lymphoma. He successfully underwent mechanical aortic valve and aortic root replacement. He underwent exchange transfusion preoperatively and one time immediately before initiating of Cardiopulmonary bypass. There was no major vaso-occlusive crisis occurred throughout the surgery. Patient was discharged in stable condition, and was scheduled for involved site radiation therapy for Hodgkin’s Lymphoma management. Conclusion: Sickle Cell Disease can be very challenging during cardiopulmonary bypass. Exchange transfusion can reduce HbS, and increase hematocrit level. Mild hypothermia can be used if sufficient CPB flows and venous saturation are maintained.

The impact of wearing a mask on face-touching behavior is unknown. We conducted a brief survey and observational study to assess the perception and to quantify how masks affect face-touching behavior. Most felt that the mask would alter their face-touching behavior with only 18.3% feeling that masks would not affect it. During a total of 330 person-minutes of observation, overall face-touching rate was 15.1 face touches/hour (FT/hr), 6.4 FT/hr while wearing a mask and 20.1 FT/hr without a mask (p <0.01). Masks are an effective barrier and reduce face-touching behavior amongst healthcare professionals.

Background: Among pediatric hematopoietic stem cell transplant (HSCT) recipients, abnormal glycemic control is shown to be associated with increased risk of transplant-related mortality, death from any cause, risk of infection, increased hospitalized and intensive care days. Independent effects of higher glycemic variability, a component of glycemic control, have not been described. This study aimed to characterize risk factors for, and consequences of, higher glycemic variability in HSCT patients. Procedure: Medical records for a cohort of 344 patients, age 0-30 years, who underwent first HSCT from 2007–2016 at Children’s Hospital Colorado were retrospectively reviewed. Glucose coefficients of variation (CV) were analyzed for HSCT days -14 to 0 and 0-30, and patients were assessed for potential risk factors and outcomes. Results: Roughly one third of patients had pre-HSCT and day 0-30 glucose CV above the reported healthy adult range. Independent of HSCT type, doubling of pre-HSCT glucose CV was associated with a 4.91-fold (95% CI 1.40-17.24) increased hazard of infection, as well as increased risk for intensive care hospitalization for allogenic HSCT patients. Multivariable analysis demonstrated that allogeneic HSCT patients had a 1.40- and 1.38-fold (95% CI 0.98-1.99 and 1.00-1.91) increased hazard of death for every doubling of pre-HSCT and Day 0-30 glucose CV, respectively. Conclusions: Just as with higher mean glucose, higher glycemic variability in the pediatric HSCT population is independently associated with significantly increased morbidity. Additional research is required to evaluate the utility of glucose control to mitigate these relationships and improve HSCT outcomes.

Our patient was diagnosed with multisystemic Langerhans Cell Histiocytosis (LCH) at 5 months of age. She received an allogeneic matched unrelated transplant for refractory haematopoietic disease. 2 years later she represented with raised intracranial pressure and an MRI confirmed the presence of a large left posterior fossa mass with homogenous enhancement and cystic areas, abnormal spectroscopy pattern, minor diffusion restriction and associated triventricular hydrocephalus. With the exception of CD1a and Langerin negativity, in contrast with initial diagnostic skin biopsy, the lesion was consistent with a diagnosis of LCH. BRAF V600E mutation was present on the cerebellar and skin sample.

Rice cake is a traditional Japanese food. Interestingly, rice cake can stay in the intestine due to its stickiness and cause food-induced ileus. This case shows an example of intestinal obstruction caused by rice cake. Globalization of Japanese food culture necessitates a deeper understanding of such a characteristic disease.

Aortic valve disease is frequently associated with ascending aorta dilatation and can be treated either by separate replacement of the aortic valve and ascending aorta or by a composite valve graft. The type of surgery is depending on the exact location of the aortic dilatation and the concomitant valvular procedures required. The limited evidence for elective aortic surgery in elderly high-risk patient remains challenging and therefore alternative strategies could be warranted. We describe an alternative strategy for the treatment of ascending aortic aneurysm and aortic valve pathology with the use of a sutureless, collapsible, stent mounted aortic valve prosthesis.

A 74-year-old female with cervical cancer post radical hysterectomy developed bilateral ureter stricture with pyonephrosis. Retrograde ureteric stent was performed and it was considered an effective procedure other than percutaneous nehrostomy and nephrectomy.

This is a report of an 8-year-old male with Schwartz-Jampel syndrome with severe obstructive sleep apnea. Dental findings include severe maxillary crowding, posterior crossbite, missing lower incisors, and supernumerary lower premolar. Significant craniofacial characteristics include Type I skeletal relationship with bimaxillary hypoplasia, hyperdivergent skeletal pattern, severe constriction of dental arches.

Comment on: The COVID-19 Pandemic: A rapid global response for children with cancer from SIOP, COG, SIOP-E, SIOP-PODC, IPSO, PROS, CCI and St. Jude Global.Chetan Dhamne MSc MD1, Tushar Vora MD1, Maya Prasad MD1, Nirmalya Roy Moulik MD PhD1, Badira C Parambil MD DM1, Akanksha Chichra MD1, Girish Chinnaswamy MD1, Shripad Banavali MD1, Gaurav Narula MD11 Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India2. Homi Bhabha National Institute, Anushaktinagar, Mumbai, IndiaCorrespondence to:Gaurav Narula Pediatric Hematolymphoid Disease Management Group, Department of Medical Oncology, Tata Memorial Center, Parel Mumbai, 400012 Email: narulag@tmc.gov.inText word count: 576Brief running title: Letter to Editor (COVID-19) Global responseKeywords: COVID-19, SARS-CoV2, Pediatric Oncology, Children with cancerTables: 1Abbreviations

Populations with higher genetic diversity and larger effective sizes have greater evolutionary capacity (i.e., higher adaptive potential) to respond to ecological stressors. We are interested in how the adaptive potential captured in protein-coding genes persists in small populations and how it fluctuates relative to overall genomic diversity. We analyzed individual whole genome sequences from different populations of Montezuma Quail (Cyrtonyx montezumae), a small ground-dwelling bird that is sustainably harvested in some portions of its range but is of conservation concern elsewhere. Our historical demographic results indicate that overall, Montezuma Quail populations in the U.S. exhibit low levels of genomic diversity due in large part to long-term declines in effective population sizes over nearly a million years. The smaller and more isolated Texas population is significantly more inbred than the large Arizona and the intermediate-sized New Mexico populations. The Texas gene pool has a significantly lower proportion of deleterious alleles than the Arizona gene pool, but also significantly more high-frequency deleterious alleles that, coupled with elevated inbreeding, elevate the realized genetic load in Texas. Our results highlight that although small, isolated populations can maintain adaptive potential (i.e., genic diversity can still be high), they are at higher risk of inbreeding depression as detrimental mutations rise in frequency due to drift and weakened purifying selection. Our study illustrates how population genomics can be used to proactively assess both neutral and adaptive aspects of contemporary genetic diversity in a conservation framework while simultaneously considering deeper demographic histories.

Liquid phase dispersion/mixing studies have been performed for the first time on the catalyst bed of a cold flow scaled-down upflow moving bed re- actor (MBR) using residence time distribution (RTD) at various flow rates including the scaled down condition. MBR is hydrotreater and its design includes catalyst bed with conical bottom and plena. The catalyst bed is modeled using Wave Model, and its mixing parameters are estimated using a mathematical approach based on convolution and regression. A study is also shown to illustrate the limitation of Axial Dispersion Model (ADM) while modeling the flow which noticeably deviates from plug flow. In addition, a dimensionless variance is also estimated for the bed region from the RTDs. Overall liquid dispersion/mixing is seen high in MBR, with more disper- sion/mixing in the expanded bed region. Scaled down conditions are seen best when considering the overall catalyst utilization and liquid mixing for hydrotreatment.

KeywordsAviptadil, Vasoactive Intestinal Peptide, VIP, SARS-CoV-2, COVID-19, Corona Virus, Acute Respiratory Distress Syndrome, ARDS, Acute Lung Injury, ALI, surfactant, Alveolar Type II, ATII

In this study, the detoxification and distribution mechanisms of fluorine during the spent potlining (SPL) incineration were characterized. CaSiO3, CaO, Ca(OH)2, and CaCO3-assissted SPL incineration detoxified NaF in the bottom ash yielding a conversion range of 54.24 to 99.45% relative to the individual SPL incineration. The fluorine leaching content of the bottom ash was estimated at 13.71 mgL-1 after the SPL co-incineration with CaSiO3 (Ca:F=1.2:1). The two main mechanisms of the fluorine transformation were the substantial formations of CaF2, and Ca4Si2O7F2. The fluorine transformation efficiency was greater with CaSiO3 than CaO, Ca(OH)2, and CaCO3. Fluorine during the SPL co-incineration with CaSiO3 (Ca:F=1.2:1) at 850 °C for 60 min was partitioned into 83.37, 13.90 and 2.72% in the bottom ash, fly ash, and flue gas, respectively. The transformation and detoxification mechanisms of fluorine provide new insights into controls over fluorine emission from the SPL incineration.

A field experiment was performed in reconstructed mine substrates (RMS) constituted with coal gangue and fly ash, and sludge was added to the RMS in order to speed up the reclamation process. The effect of sludge addition on plant growth, microbial activity, soil aggregate stability and aggregation-associated soil characteristics in 9-year chronosequences was monitored. The results showed that the height and the total biomass of ryegrass with sludge amendment increased with the reclamation time and eventually reached 1.5 times and 4.3 times respectively higher than the control (CK1) after 9 years. The sludge amendment enhanced the content of aggregate binding agents such as SOC and glomalin and the soil aggregate stability. The SOC, LFOC and HFOC in RMS were increased by 151.35%, 247.41% and 132.82% over the CK1, respectively. Besides, the tested variables in RMS after 3-7 years were insignificantly different from them in the treatment without sludge amendment after 9 years. A similar trend was also observed for GRSP. Furthermore, a significant positive correlation between GRSP and SOC was investigated in RMS, as well as GRSP and soil structure-related variables. Biological stimulation of SOC and GRSP to soil accelerated the recovery of soil structure and ecosystem function. As a result, the sludge amendment can be used as an effective technique in soil restoration.

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Rational: In March 2020, the World Health Organization (WHO) declared the coronavirus infectious disease as a pandemic referred to as COVID-19. As an essential service, community pharmacists have been enacting a key role in patient counseling and supply of essential medicines and protective equipment. Objectives: To investigate pharmacists’ perspectives of the role of educational institutes and professional pharmacy organizations in supporting them to take on roles during COVID-19 pandemic and to identify barriers to be able to support themselves and their patients. Methods: This descriptive mixed-method study was conducted via a cross-sectional online survey distributed to pharmacists/pharmacy students in Jordan during the COVID-19 outbreak (15-30 March 2020) using an online questionnaire, followed by an online focus group. Questionnaire items related to participants’ perspectives in being prepared for and supported in their roles during the COVID-19 pandemic and items were tested for face validity. Data were descriptively analyzed using the Statistical Package for the Social Sciences and triangulated with focus group findings. Results: Considering that fear and anxiety are a consequence of mass social distancing/quarantine, study participants (n=726, age=26.9 (SD=8.0) years, 71.9% females), reported needing training on mental healthcare to be able to support themselves and people during pandemics (90.2%). Most respondents agreed/strongly agreed (59.7%) with the statement around pharmacy educators/educational institutes having a key role in preparing pharmacists for practice during epidemics/pandemics, and agreed that their faculties should add a course regarding pandemic preparedness in their curriculum (89.9%). Results were similar regarding roles for the pharmaceutical associations. Focus group findings (n=7) mirrored the survey findings to a large extent. Conclusions: Most participants believed that Pharmacy Educators and pharmaceutical associations have a role in preparing them to deal with the COVID-19 pandemic through online educational workshops/webinars. Online education on mental healthcare is specifically needed.

Salicylic acid (SA) is an important signal molecule, regulating oxidative stress response in plants. In this study, we evaluated the influences of SA (1mg L-1, 10mg L-1 and 50mg L-1) on the accumulation of clothianidin (CLO), dinotefuran (DFN) and difenoconazole (DFZ) (5mg L-1) and pesticide-induced (CLO-10mg L-1, DFN-20 mg L-1, and DFZ-10mg L-1) oxidative stress in cucumber plants. Exogenous SA at 10mg L-1 significantly reduced the half-lives of three pesticides in nutrient solution and prevented the accumulation of pesticides in roots and leaves. And the role of SA in reducing residues was related to the major accumulation sites of pesticides. By calculating the root concentration factor (RCF) and translocation factor (TF), we found that SA at 10mg L-1 reduced the ability of roots to absorb pesticides and enhanced the translocation ability from roots to leaves. Roots exposed to high concentrations of three pesticides could reduce biomass, low chlorophyll content, promote lipid peroxidation, and alter the activities of a range of antioxidant enzymes, respectively. Exogenous SA at low concentrations significantly mitigated these negative effects. Hence, we speculated that application of exogenous SA at 10 mg L-1 could effectively alleviate the accumulation of pesticides and induce stress tolerance in cucumber planting systems.