Background and Purpose: Pudilan (PDL), a four-herb prescription with the traditional function of heat-clearing and detoxifying, has been used for anti-SARS-CoV-2 infection, anti-inflammation effect, and clear infection. PDL is one of the therapeutic potentials for COVID-19 while the underlying mechanisms remain to be clarified. Experimental Approach: We used network pharmacology analysis, and selected 68 co-targeted genes/proteins as targets of both PDL and COVID-19. These co-targeted genes/proteins were predicted by SwissDock Server for their high-precision docking simulation, and analyzed by STRING for proteins to protein interaction (PPI), pathway and GO (gene ontology) enrichment. WebGestalt (WEB-based Gene SeT AnaLysis Toolkit) was used for gene set enrichment analysis (GSEA) for functions and pathways enrichment. The therapeutic effect for PDL treatment on COVID-19 was validated by the TCMATCOV (TCM Anti COVID-19) platform. Key Results: PDL may prevent the entrance of SARS-CoV-2 entry into cells by blocking the angiotensin-converting enzyme 2 (ACE2). It may inhibit the cytokine storm by affecting C-reactive protein (CRP), interferon-γ (IFN-γ), interleukin- 6 (IL-6), interleukin- 10 (IL-10), tumor necrosis factor (TNF), epidermal growth factor receptor (EGFR), C-C Motif Chemokine Ligand 5 (CCL5), transforming growth factor-β1 (TGFβ1), and other proteins. PDL may moderate immune system to shorten the course of the disease, delay disease progression and reduce the mortality rate. Conclusion and Implications: We showed the molecular mechanism of PDL treatment for COVID-19. Based on previous studies, PDL was proven to be useful in the treatment of COVID-19 via different levels studies including clinical practice, animal experiments, cell testing, and network pharmacology.

The aromaticity of boron-nitrogen clusters has been revisited through a systematic analysis using magnetic criteria. The results obtained through Ring Current Strength (RCS) measurements indicate that B2N2 has a strongly antiaromatic character, even the bond pattern analysis reveals that this system is doubly antiaromatic presenting two σ- and two π-orbitals of 4c-2e, according to the Adaptive Natural Density Partitioning bond pattern analysis (AdNDP) and z-component of the dissected Nucleus Independent Chemical Shift (NICSzz) isolines. B4N4 and B6N6 are marginally antiaromatic according to RCS and the bond pattern suggest four and six 8c-2e and 12c-2e delocalized π-orbitals respectively. B3N3 and B5N5 are slightly aromatic, with a bond pattern of three and five 6c-2e and 10c-2e π-orbitals respectively. All rest of the systems (x = 7 – 11) are non-aromatic. The results show some discrepancies with results based on the classical nucleus independent chemical shift, which can be attributed to tensor in-plane and core electron contributions. Finally, presented results reveal the need to be careful with the interpretations given by this index, so it will be necessary the use of 1D, 2D or 3D derived methodologies for a complete and correct analysis of (anti)aromaticity.

Background and Purpose Airway hyperresponsiveness (AHR) is a central abnormality in asthma. Interleukin-5 (IL-5) may modulate AHR in animal models of asthma, but inconsistent data are available on the impact of targeting IL-5 pathway against AHR. The difference between targeting IL-5 or IL-5Rα in modulating AHR remains to be understood in human airways. The aim of this study was to compare the role of the anti-IL-5Rα benralizumab and the anti-IL-5 mepolizumab against AHR, and to assess whether these agents influence the levels of cyclic adenosine monophosphate (cAMP). Experimental Approach Passively sensitized human airways were treated with benralizumab and mepolizumab. The primary endpoint was the inhibition of AHR to histamine; the secondary endpoints were the protective effect against AHR to parasympathetic activation and mechanical stress, and the tissue modulation of cAMP. Key Results Benralizumab and mepolizumab significantly (P<0.001 vs. positive control) prevented the AHR to histamine (maximal effect -134.14±14.93% and -108.29±32.16%, respectively), with benralizumab being 0.73±0.10 logarithm significantly (P<0.05) more potent than mepolizumab. Benralizumab and mepolizumab significantly (P<0.001 vs. positive control) inhibited the AHR to transmural stimulation and mechanical stress. Benralizumab was 0.45±0.16 logarithm significantly (P<0.05) more potent than mepolizumab against AHR to parasympathetic activation. The effect of these agents was significantly correlated (P<0.001) with increased levels of cAMP. Conclusion Targeting the IL-5/IL-5Rα axis is an effective strategy to prevent the AHR. Benralizumab resulted more potent than the mepolizumab and the concentration dependent beneficial effects of both these agents were related with improved levels of cAMP in hyperresponsive airways.

Background: The use of immunotherapy to treat recurrent/metastatic squamous cell carcinoma of the head and neck has become a popular research topic in recent years, and many clinical trials have been carried out. Objectives: To systematically evaluate the efficacy and safety of PD-1/PD-L1 inhibitors in the treatment of recurrent/metastatic head and neck squamous cell carcinoma. Methods: We searched PubMed, Embase, Cochrane Library and other databases up to 1 November 2019 for publications reporting the use of PD-1/PD-L1 inhibitors in the treatment of squamous cell carcinoma of the head and neck. Revman 5.0 was used for combination analysis, and the overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and adverse events were determined. Results: Five articles were included. Compared with other treatment methods, this meta-analysis showed that treatment with PD-1/PD-L1 inhibitors can significantly improve OS (P < 0.0001), but there was no significant improvement in PFS or ORR. The risk of anaemia and nausea was significantly reduced by treatment with PD-1/PD-L1 inhibitors. Conclusions and Significance: Treatment with PD-1/PD-L1 inhibitors alone can improve the overall survival rate for recurrent/metastatic squamous cell carcinoma of the head and neck but there is no obvious advantage in other aspects and adverse events.

Background: Increasing the use of tobacco by the younger generation has increased in oral cavity tumours. Surgical treatment is radical and results in severe functional morbidity. Using computer-aided designing technology, surgical and rehabilitative planning can be better. We present here our concept of a biomechanical 3D tongue model and its clinical utility in the management of tongue tumours. Methods: Patients diagnosed with Carcinoma of Tongue were included. These patients underwent a pre-operative Magnetic Resonance Imaging (MRI) of the head and neck region at our center. These patients were informed about the use of a 3D biomechanical patient-specific model for treatment planning and execution. Using Materialise Mimics Innovation Suite 19 DICOM data was imported, visualized, edited and segmented. Flashforge ‘Creator-pro’3D Printer was used for 3D Printing. Fused Deposition Modeling (FDM) technology was used to print the tumour and uninvolved tongue in two different colors for easy identification. These patients underwent surgery with the 3D model serving as a guide for margins. Results: Two patients with stage III squamous cell carcinoma of tongue underwent the surgery based on the plan evolved from the 3D model. All the surgical margins were clear. The model helped address the discordance between patient expectations and surgical outcomes. We found that the model aided the reconstructive surgeon to plan the flap volume better and this translated into better rehabilitative outcomes. Discussion and Conclusion: The 3D biomechanical tongue model is a novel concept and may aid in improving our overall treatment outcomes.

The use of ultrasound enhancing agents (UEA) help optimize visualization in technically difficult studies, with improved left ventricular opacification and endocardial border definition. The use of these agents may often unveil critical data that drastically alter clinical management. Despite the clinical benefit of using UEA, it is sometimes not used routinely in emergency situations with an unstable patient for many reasons. Herein, we demonstrate a challenging case of late presentation myocardial infarction complicated with cardiogenic shock and pseudoaneurysm formation that was not observed in non-contrast images emblematically demonstrating how the use of ultrasound enhancing agents can drastically impact clinical decision-making.

BACKGROUND: the outbreak of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in more than 150000 infected individuals and more than 20000 deaths in Italy. Viral acute pneumonitis is the major cause of morbidity and mortality, but there is increasing evidence that COVID-19 patients show a variable degree of vascular complications, due to a possible hypercoagulability status. OBJECTIVE: to report thrombotic events in abdominal and lower-limb arteries of COVID-19 patients (abdominal aorta, superior mesenteric artery, femoral arteries, cardiac, spleen and kidney). METHODS: we retrospectively reviewed our clinical records of patients with confirmed SARS-CoV-2 infection, admitted from March 1st to April 6th, 2020, to a tertiary care center in Brescia, Italy. We selected five patients with major arterial thrombo-embolic manifestations. RESULTS AND CONCLUSION: In our opinion, arterial thrombotic events may be more common in COVID-19 patients than in general population, possibly resulting in rapid worsening of patient conditions.

Objective: Numerous clinical practice guidelines (CPGs) for the corona virus disease 2019 (COVID-19) have been developed since its outbreak. To date, however, the methodological quality of these guidelines has not been fully evaluated. Quality evaluation of the guidelines is to facilitate the clinic practitioners in diagnosis and treatment of the COVID-19. Methods: The evaluation was conducted by searching seven databases and government organizations websites (December 2019 to March 2020). Four assessors assessed the quality of the CPGs independently with the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. For domain scores (0-100%), >60% were considered of sufficient quality, and >80% of good quality. Results: Of 471 retrieved records, 20 guidelines were included. The median score for the domain of scope and purpose was 56.9% (range 40.3–90.3%) and nine guidelines scored >60%, among which three guidelines scored >80%. The median score for the stakeholder involvement domain was 7% (range 0–65.3%) and only two guidelines scored >60%. Nine guidelines scored 0% in this domain. The median score for the rigour of development domain was 0% (range 0–91.7%) and fourteen guidelines scored 0% in this domain. The median score for the clarity of presentation domain was 30.6% (range 13.9–91.7%) and six guidelines scored >60%, among which three guidelines scored >80%. The median score for the applicability domain was 0% (0–57.3%) and eleven guidelines scored 0% in this domain. The median score for the editorial independence domain was 0% (0–100%): four guidelines scored >80%. Discussions：Three guidelines were recommendable, and four were recommendable with modification in the stakeholder involvement, the rigour of development, and the applicability domains. Our results could contribute to improve development of future guidelines, and affect the reasonable selection and use of guidelines in clinical practice.

Background Displacement of Impella 5.0 secondary to patient movement or transportation is a well known complication. Typically, repositioning of an Impella across the aortic valve is attempted over a guidewire. We present the first case, to our knowledge, of repositioning a dislodged Impella 5.0 without a guidewire under transesophageal echocardiography (TEE) guidance, by inducing rapid ventricular pacing to cross the aortic valve. Case presentation: A 70-year-old man with low left ventricular ejection fraction underwent off-pump coronary artery bypass grafting (OPCABG). On 2nd postoperative day a low cardiac output state developed with increasing lactate levels and consequently the patient was taken to the cardiac catheterization laboratory for insertion of an Impella 5.0. Suddenly the Impella system failed with a rapid hemodynamic deterioration and it was successfully bedside repositioned inducing rapid ventricular pacing. Conclusions: In case of accidental Impella dislodgement and fast deterioration of patient’s hemodynamic status, rapid pacing may be an option to “open” the aortic valve thus aiding quick replacement of Impella 5.0 through the aortic valve into the left ventricle under TEE guidance.

Coronary artery bypass grafting (CABG) remains the preferred revascularization modality for the elective treatment of patients with complex three vessel coronary artery disease. There is evidence that the use of additional arterial grafts such as right internal mammary artery (RIMA) and Radial Artery (RA); are associated with improved long-term patency. Stenosis of arterial grafts can occur in some patients postoperatively. We describe the first use of OCT in the evaluation of suspected conduit stenosis in Total Arterial Revascularisation.

We present the clinical case of a 60-year-old woman complained of dyspnea on exertion. Echocardiogram showed a giant mass in right ventricle (RV) with obstruction to the outflow tract. Thorax CT confirmed a mass of >60 mm infiltrating RV and causing severe stenosis in pulmonary artery, with severe pericardial effusion. Cardiac surgery was performed for tumor resection and pulmonary root replacement with a biological valved conduit. Histological analysis diagnosed a poorly differentiated large-cell neuroendocrine carcinoma. The patient had no immediate postoperative complications and has completed radiotherapy at 6-month follow-up.

The 2019 Coronavirus Panademic challenges the delivery of care for patients with head and neck cancer.  An important aspect of this care has been the evolution of enhanced survivorship services which include surveillance for recurring cancer and prevention of second primaries.  The application of evidence based approaches to identification and management of treatment and tumor related toxicities has embraced the use of validated patient reported outcomes instruments (PROs), health promotion, and care coordination.  In this manuscript we describe how our multidisciplinary team of survivorship providers have accommodated to the need to provide patients with social distancing while acknowledging the importance of continued care during treatment and through the spectrum of survivorship.

The novel coronavirus disease 2019 (COVID-19) pandemic continues to have extensive effects on public health as it spreads rapidly across the globe. Head and neck cancer patients are a particularly susceptible population to these effects, and we expect there to be a potential surge in patients presenting with head and neck cancers after the surge in COVID-19. Furthermore, the impact of social distancing measures could result in a shift towards more advanced disease at presentation. With appropriate anticipation, multidisciplinary head and cancer teams could potentially minimize the impact of this surge and plan for strategies to provide optimal care for head and neck cancer patients.

IntroductionThe ongoing worldwide pandemic due to COVID-19 has forced drastic changes on the daily lives of the global population. This is most notable within the healthcare sector. The current paper outlines the response of the head and neck oncologic surgery (HNS) division within our academic otolaryngology department in the state of Alabama.MethodsData with regard to case numbers and types were obtained during the pandemic and compared with time matched data. Our overall approach to managing previously scheduled and new cases, personal protective equipment (PPE) utilization, outpatient clinic, and resident involvement is summarized.DiscussionOur HNS division saw a 55% reduction in surgical volume during the peak of the COVID-19 pandemic. We feel that an early and cohesive strategy to triaging surgical cases, PPE usage, and minimizing exposure of personnel is essential to providing care for HNS patients during this pandemic.

The SARS-CoV-2 pandemic has rapidly transformed healthcare delivery around the globe. Because of the heavy impact of COVID-19 spread, cancer treatments have necessarily been de-prioritized, thus exposing patients to increased risk of morbidity and mortality due to delayed care. In this scenario, cancer specialists need to assess critical oncology patients case by case to carefully balance risk versus benefit in treating tumors and preventing SARS-CoV-2 infection. Here we report early insights into how the management of patients with sinonasal and anterior skull base cancer might be affected by the COVID-19 pandemic. We provide recommendations for preoperative tests, indications for immediate care versus possible delayed treatment, warnings relating to dural resection and intracranial dissection given the potential neurotropism of SARS-CoV2 and practical suggestions for managing cancer care in a period of limited resources. We also postulate some thoughts on the promising role of telemedicine in multidisciplinary case discussions and post-treatment surveillance.

Introduction For the ENT surgeon there are many challenges that show-up in the clinical management of a patient affected by a Head and Neck cancer during COVID-19 pandemic, especially in the postoperative period. Methods During the acute COVID-19 emergency phase in Italy, we analysed the management of a patient affected by a Head and Neck cancer. We reported several clinical data about the hospitalization period, pointing out the difficulties encountered both from clinical and management point of view. Results During pandemic, we admitted 27 oncological patients at our ENT department. Delays in surgical procedures, complications of hospitalizations, need for radiological studies and possible transfer to other hospital ward, due to suspect Sars-CoV-2 infection, were registered. Conclusions The changes in the whole health care system during the COVID-19 pandemic have impacted the management of head and neck cancer patients, generating several clinical challenges for the ENT surgeon.

AIM: The COVID-19 pandemic has resulted in society experiencing unprecedented challenges for healthcare practitioners and facilities serving at the frontlines of this pandemic. With regards to oral cancer, there is a complete absence of literature regarding the long-term impact of pandemics on patients with oral potentially malignant disorders (OPMDs). The objective of this article is to put forth an institutional multidisciplinary approach for the evaluation and management of OPMDs. METHODS: A multidisciplinary approach was put formalized within our institution to risk stratify patients based on need for in-person assessment versus telehealth assessment during the COVID-19 pandemic. RESULTS: With judicious risk stratification of patients based on clinical features of their OPMD and with consideration of ongoing mitigation efforts and regional pandemic impact, providers are able to safely care for their patients.  CONCLUSIONS: The COVID-19 pandemic has required healthcare practitioners to make novel decisions that are new to us with development of creative pathways of care that focused on patient safety, mitigation efforts, and clinical management of disease processes. The care of patients with OPMDs requires special considerations especially as patients at high-risk for severe COVID-19 illness are also higher risk for the development of OPMDs.

Soluble mesothelin-related peptide (SMRP) is a promising biomarker for malignant pleural mesothelioma (MPM), but several confounding factors can reduce SMRP-based tests accuracy. The identification of these confounders could improve the diagnostic performance of SMRP. In this study, we evaluated the sequence of 1000 base pairs encompassing the minimal promoter region of MSLN gene to identify expression quantitative trait loci (eQTL) that can affect SMRP. We assessed the association between four MSLN promoter variants and SMRP levels in a cohort of 72 MPM and 677 non-MPM subjects, and we carried out in vitro assays to investigate their functional role. Our results show that rs2235503 is an eQTL for MSLN associated with increased levels of SMRP in non-MPM subjects. Furthermore, we show that this polymorphic site affects the accuracy of SMRP, highlighting the importance of evaluating the individual’s genetic background and giving novel insights to refine SMRP specificity as a diagnostic biomarker.

Microsporidia are obligate intracellular eukaryotic parasites that infect nearly all animal groups, including humans. The most common molecular methods for Microsporidia detection rely on species-targeting qPCR or end-point PCR using group-specific primers. However, these methods could be not specific enough or fail in case of mixed infections. We developed a method for parallel detection of both microsporidian infection and the host species. We designed new primer sets: one specific for the classical Microsporidia (targeting hypervariable V5 region of ssu rDNA), and a second one targeting a shortened fragment of the COI gene (standard metazoan DNA-barcode); both markers are well suited for a NGS approach. The analysis of ssu rDNA dataset representing 607 microsporidian species (120 genera) indicated that the V5 region enables identification of >98% species in the dataset (596/607). To test the method, we used microsporidians that infect mosquitoes in natural populations. Using mini-COI data, all field-collected mosquitoes were unambiguously assigned to seven species; among them almost 60% of specimens (127/212) were positive for at least 11 different microsporidian species, including a new microsporidian ssu rDNA sequence (Microsporidium sp. PL01). Phylogenetic analysis of Microsporidium sp. PL01 ssu rDNA showed that this species belongs to one of the two main clades in the Terresporidia. In addition, the level of microsporidian mixed infections was relatively high (9.4%). The numbers of sequence reads for the OTUs suggest that the occurrence of Nosema spp. in co-infections could benefit them; however, this observation should be re-tested using more intensive host sampling. The proposed method for detection of Microsporidia can be applied to all types of DNA extracts, including medical and environmental samples.

Two formulae were developed to express sublimation enthalpy and Young’s modulus on a thermodynamic basis. The first formula reveals how the sublimation enthalpy is correlated with the thermal expansion coefficient and heat capacity of solids, whereas the second formula relates the Young’s modulus with sublimation enthalpy and equilibrium interatomic (intermolecular) distance. These two formulae provide alternative ways to quantitatively estimate thermodynamic or mechanical properties of great importance in the development of new materials.

Aims and Methods: Effect of angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on outcomes in patients with coronavirus disease 2019 (COVID-19) is uncertain. Available evidence is limited to a few retrospective observational studies with small number of patients. We did a meta-analysis to assess the effect of ACEi/ARB in patients with COVID-19 on severity of disease, risk for hospitalisation, and death compared to those not on ACEi/ARB. We searched the Cochrane library, PubMed, Embase, ClinicalTrial.gov and medRxiv for studies published until 25.04.2020. Inclusion criteria included all studies with patients with confirmed COVID-19 either taking, or not taking, ACEi/ARB. Depending on degree of heterogeneity, fixed or random effect model was selected to calculate effect size (Odds ratio). Results: Six studies were eligible for this meta-analysis. These included 423 patients on ACEi/ARB, and 1419 not on ACEi/ARB. Compared to patients with COVID-19 not on ACEi/ARB, there was a statistically significant 43% reduction (OR 0.57, CI: 0.37-0.88, I2: 0.000) in the odds of death in those on ACEi/ARB. There was a statistically non-significant 38% reduction (OR: 0.62, 95% CI: 0.31-1.23, I2=70.36) in the odds of developing severe disease and 19% reduction (OR 0.81; 95% CI: 0.42-1.55, I2: 0.000) in the odds of hospitalisation among those on ACEi/ARB. Discussion: It is safe to use ACEi/ARB in patients with COVID-19 requiring these medications for associated comorbidities. Although limited by confounding factors typical of a meta-analysis of retrospective observational studies, our data suggests that use of these medications may reduce the odds of death. Conclusion: Our meta-analysis of the updated studies on SARS-CoV-2 reassures the medical fraternity on the use of and continuation of ACEi/ARB, supporting all recent recommendations .

The healthcare workers (HCWs) are constantly battling the Corona Virus Disease 2019 (Covid-19) pandemic and they need to wear the personal protective equipment (PPE) in order to protect themselves.1 There has been a lot of uproar regarding the demand and supply of PPE and its quality. Hospitals usually check the PPE for compliance with relevant international standards but at times, it may be defective. There are instances when many of the PPE items such as aprons, gowns, respirator masks, safety glasses, shields and goggles may result in the development of allergy, especially if worn for prolong period. Interestingly, an earlier research found that 35% individuals who used the N95 masks, regularly had acne, facial dermatitis and pigmentation of the nasal bridge, cheeks and chin.2 The rubber straps and metal clips in respirator masks may also cause skin dermatitis.2 Wearing goggles for longer period may also cause skin irritation or reactions at the region of the cheek and nose. Any underlying skin disease in the HCW is also a cause of concern. This makes the use of PPE more challenging.Majority of the side- effects resulting from use of PPE are attributed to wearing of gloves. Gloves made of latex, nitrile and vinyl, may cause skin reactions and dermatitis. It may be harmful in individuals who have latex allergy. After wearing PPE, if the heat from the body is not lost through proper sweating, it may result in overheating and cause rashes in the skin. The PPE should be removed if there is overheating. An individual may also develop hypersensitivity type 1 or type IV reactions due to certain chemicals present in the PPE. There are reports of side-effects due to rubber accelerators used in surgical gloves, different types of textile dyes use in the clothing, metals used in masks and footwear, and formaldehyde and other preservatives used in N-95 respirators.3 Proper washing of the face may be necessary in individuals who have acne.We recommend that a proper PPE training courses for HCW be conducted. Any individual with history contact dermatitis or any allergic disease should be advised to take antihistaminic. A HCW may be made aware of any potential side-effects of wearing PPE and the immediate remedy to such. It is also advisable for HCW individuals to wear cotton clothes as they are better than synthetic clothes which may cause allergy. The PPE materials could also be tested regularly for any hypersensitivity.

Objectives: This study aims to determine females’ views, experiences, and attitudes regarding the cesarean section (CS) and to explore the factors that increase the prevalence of CS in Jordan. Method: This is a cross-sectional study using a questionnaire that was distributed electronically through social media websites. Study participants included 1005 females with a history of at least one CS. Awareness, experiences about CS, complications, and reasons for performing CS were investigated. Result: Most of the respondents stated that the source of there knowledge about CS was from the internet (36.2%) followed by family and friends (31.6%). The majority of respondents were satisfied with their CS experience (72.=8%). More than half of the participants (56.9%) reported that CS carries no risk for infants. About 53% of respondents stated that the most common reason leading women to choose to give birth via CS is the fear of labor pain. However, the majority of the respondents disagree with performing CS under maternal request (59.2%). Conclusion: This study indicated that Jordanian females don’t have reliable sources of information about CS. This leads to lower awareness of CS and its complications and, as expected, CS is more likely to be performed by privately insured women.

There have been many studies of the ecology of West Nile Virus (WNV) in the US, including the role of different bird species as reservoirs and mid-late summer shifts of feeding of Culex pipiens-restuans (CPR) mosquitoes from birds to mammals. It is often assumed that these findings are generalizable to neighbouring regions of Canada where WNV is endemic; however there have been little equivalent studies in Canada to confirm that this is reasonable. Here we construct a priority list of bird species likely involved in the transmission of WNV in the greater Montreal area by combining three sources of data i) results of WNV surveillance in wild (dead) birds in the province (2002-2015); ii) evidence from molecular blood meal analysis that bird species are fed upon by CPR, the primary enzootic vectors of WNV in the region, collected in mosquito surveillance in the study area in 2008 and 2014; and iii) a literature review on evidence of sero-prevalence and host competence of resident bird species. Three lists of 18, 23 and 53 bird species, respectively, from the three data sources, and totalizing 67 bird species were identified as potential WNV reservoirs/amplifiers. Of the 23 species identified from CPR blood meals, Common starlings, American robins, Song and House sparrows ranked the highest as possible WNV reservoirs/amplifiers. In addition, we found using logistic regression that the proportion of blood meals taken from birds compared to mammals by CPR declined significantly with surveillance week. These findings indicate broad similarity in the ecology of WNV between the study region and northeastern US although the relative importance of some bird species as hosts of CPR and WNV in this area may be somewhat different, and field studies are needed to confirm this, and explore the consequences for the risk of WNV to the human population.