Verifying the feasibility of wastewater-based epidemiological monitoring for the small catchment and sewage networks with significant pretreatment.

Wastewater-based epidemiology (WBE) has emerged as a valuable tool for COVID-19 monitoring, especially as the frequency of clinical testing diminishes. Beyond COronaVIrus Disease 19 (COVID-19), the tool's versatility extends to addressing various public health concerns, including antibiotic resistance and drug consumption. However, the complexity of sewage systems introduces noise when measuring chemical tracer concentrations, potentially compromising their applicability for modeling. In our study, we detail the approach adopted to determine the concentration of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) ribonucleiec acid (RNA) in wastewater from the Ponte a Niccheri wastewater treatment plant in Tuscany (Italy), with a sample size of N = 13,935 inhabitants. The unique characteristics of this wastewater system, including mandatory pretreatment in septic tanks with extended retention times, the presence of a hospital for COVID-19 patients, and mixed sewage networks, posed additional challenges. Nevertheless, our results highlight a robust and significant correlation between our measurements and the number of infections within the wastewater treatment plant's catchment area at the time of sampling. A simple linear model also shows promising results in estimating the number of infected people within the area.

Beliefs, preferences, and acceptance of personal protective equipment for a shock room team in a tertiary care center.

BACKGROUND: During coronavirus disease of 2019 pandemic a standard usage of personal protective equipment (PPE) in healthcare was mandatory, while actually the usage of PPE is currently decreasing. This raises the question about the further use of PPE in the clinical setting because healthcare workers (HCW) are at greater risk of being infected with SARS-CoV-2 than the general population. The primary objective of this study is to determine the proportion of shock room team members approving the further use of PPE including a FFP2 respirator in simulation training and reality. The secondary objectives are to describe the expertise and difficulties faced while using PPE in the shock room care. METHODS: Fifty-four HCW participated in a shock room simulation training at a large urban tertiary care hospital in Germany, utilizing a PPE comprising an FFP2 mask, gloves, goggles, and gown. Subsequently, participants completed an online questionnaire featuring 15 questions presented on a 5-point Likert scale or as multiple-choice questions with predefined answers. RESULTS: Sixty-eight point five percent of our participants voted for an established standard PPE in shock room care. The largest fraction of our participants (40.7%) favors a standard PPE consisting of FFP2 mask, gown, and gloves. Less HCW (31.5%) want to wear PPE in shock room simulation training. Except for goggles we could not detect relevant difficulties faced while using PPE in the shock room environment. Incorrect use of PPE was observed in 14.8%. CONCLUSION: A majority of our participants favored a standard PPE including a FFP2 respirator in shock room care. In addition, we recommend the use of PPE in shock room simulation training, while further awareness of and training in proper use of PPE seems to be necessary to reduce risk of infectious diseases for HCW.

A potent, broadly neutralizing human monoclonal antibody that efficiently protects hACE2-transgenic mice from infection with the Wuhan, BA.5, and XBB.1.5 SARS-CoV-2 variants.

The COVID-19 pandemic has uncovered the high genetic variability of the SARS-CoV-2 virus and its ability to evade the immune responses that were induced by earlier viral variants. Only a few monoclonal antibodies that have been reported to date are capable of neutralizing a broad spectrum of SARS-CoV-2 variants. Here, we report the isolation of a new broadly neutralizing human monoclonal antibody, iC1. The antibody was identified through sorting the SARS-CoV-1 RBD-stained individual B cells that were isolated from the blood of a vaccinated donor following a breakthrough infection. In vitro, iC1 potently neutralizes pseudoviruses expressing a wide range of SARS-CoV-2 Spike variants, including those of the XBB sublineage. In an hACE2-transgenic mouse model, iC1 provided effective protection against the Wuhan strain of the virus as well as the BA.5 and XBB.1.5 variants. Therefore, iC1 can be considered as a potential component of the broadly neutralizing antibody cocktails resisting the SARS-CoV-2 mutation escape.

Cross-National Strategic Aeromedical Evacuation at the European Air Transport Command.

INTRODUCTION: The European Air Transport Command (EATC) is a seven-nation integrated command. One of its core capabilities is strategic aeromedical evacuation (AE). During the global COVID-19 pandemic and Ukrainian crisis, EATC proved that acting in concert is a valuable, effective, and reliable option.METHODS: By pooling and sharing aircraft and personnel, EATC has privileged access to a diverse fleet and pool of experts. Cooperation is based on a common set of rules and regulations, which ensures that EATC can address any problem with expertise.RESULTS: During the COVID-19 pandemic, 1060 COVID-19-positive patients were transported in 198 missions, with neither death nor disease transmission reported during those strategic AE flights. EATC transferred 986 military cases, mostly routine priority (91.4%); the other 74 cases were civilians, who were transported in 17 missions, with 81.1% categorized as urgent. During the Ukrainian crisis, 251 patients were transported, 112 military and 139 civilians, including 30 children. Among the recorded injuries were cerebrocranial, abdominal, and chest injuries, as well as fractures (180) and amputations (48) of the extremities.DISCUSSION: EATC is recognized as a center of expertise within the AE community, where interoperability and harmonization of concepts are key to safety and success. Cross-national missions, where a patient is evacuated by an aircraft and medical crew provided by another nation, offer maximum flexibility. Complex situations, such as the COVID-19 pandemic and the Ukrainian crisis, have shown that multinational cooperation is not only achievable but also provides robust, effective, and reliable solutions for AE in particular.Fiorini A, Vermeltfoort R, Dulaurent E, Hove MG, Borsch M. Cross-national strategic aeromedical evacuation at the European Air Transport Command. Aerosp Med Hum Perform. 2024; 95(9):709-715.

The small molecule inhibitor of SARS-CoV-2 3CLpro EDP-235 prevents viral replication and transmission in vivo.

The COVID-19 pandemic has led to the deaths of millions of people and severe global economic impacts. Small molecule therapeutics have played an important role in the fight against SARS-CoV-2, the virus responsible for COVID-19, but their efficacy has been limited in scope and availability, with many people unable to access their benefits, and better options are needed. EDP-235 is specifically designed to inhibit the SARS-CoV-2 3CLpro, with potent nanomolar activity against all SARS-CoV-2 variants to date, as well as clinically relevant human and zoonotic coronaviruses. EDP-235 maintains potency against variants bearing mutations associated with nirmatrelvir resistance. Additionally, EDP-235 demonstrates a ≥ 500-fold selectivity index against multiple host proteases. In a male Syrian hamster model of COVID-19, EDP-235 suppresses SARS-CoV-2 replication and viral-induced hamster lung pathology. In a female ferret model, EDP-235 inhibits production of SARS-CoV-2 infectious virus and RNA at multiple anatomical sites. Furthermore, SARS-CoV-2 contact transmission does not occur when naïve ferrets are co-housed with infected, EDP-235-treated ferrets. Collectively, these results demonstrate that EDP-235 is a broad-spectrum coronavirus inhibitor with efficacy in animal models of primary infection and transmission.

Public perception on face mask wearing during COVID-19 pandemic in Malaysia: A cross sectional study.

INTRODUCTION: Since the emergence of COVID-19, the Malaysian government has made wearing a face mask in public mandatory since August 1, 2020, as an effort by the government to control the transmission of COVID-19. However, Malaysians' willingness to wear face masks in public is unknown. OBJECTIVE: Thus, this study aimed to evaluate their perception of face mask wearing during COVID-19 and its contributing factors. METHODOLOGY: A total of 1024 respondents, aged ≥ 18 years, participated in this online cross-sectional survey from October 2021 to December 2021. The Face Mask Perception Scale (FMPS) was used to measure their perceptions. RESULTS: Most of the respondents perceived wearing a face mask as uncomfortable. Our findings also revealed statistically significant differences and a small effect (f2 = 0.04) in which respondents who were concerned about being infected by the virus perceived face mask wearing appearance positively (B = - 0.09 units of log-transformed, 95% CI = - 0.15, - 0.04), whereas married respondents perceived it negatively (B = 0.07 units of log-transformed, 95% CI = 0.03, 0.09). There were no statistically significant differences in other domains of FMPS. CONCLUSION: In conclusion, discomfort was a major complaint. Marital status and fear of COVID-19 infection affected their perceptions. The public health implications of these findings highlight the importance of addressing discomfort and societal perceptions, particularly those influenced by factors such as marital status and COVID-19 experience, to promote widespread acceptance and consistent usage of face masks, which is crucial in mitigating the spread of COVID-19.

Personal protective effect of wearing surgical face masks in public spaces on self-reported respiratory symptoms in adults: pragmatic randomised superiority trial.

OBJECTIVE: To evaluate the personal protective effects of wearing versus not wearing surgical face masks in public spaces on self-reported respiratory symptoms over a 14 day period. DESIGN: Pragmatic randomised superiority trial. SETTING: Norway. PARTICIPANTS: 4647 adults aged ≥18 years: 2371 were assigned to the intervention arm and 2276 to the control arm. INTERVENTIONS: Participants in the intervention arm were assigned to wear a surgical face mask in public spaces (eg, shopping centres, streets, public transport) over a 14 day period (mask wearing at home or work was not mentioned). Participants in the control arm were assigned to not wear a surgical face mask in public places. MAIN OUTCOME MEASURES: The primary outcome was self-reported respiratory symptoms consistent with a respiratory infection. Secondary outcomes included self-reported and registered covid-19 infection. RESULTS: Between 10 February 2023 and 27 April 2023, 4647 participants were randomised of whom 4575 (2788 women (60.9%); mean age 51.0 (standard deviation 15.0) years) were included in the intention-to-treat analysis: 2313 (50.6%) in the intervention arm and 2262 (49.4%) in the control arm. 163 events (8.9%) of self-reported symptoms consistent with respiratory infection were reported in the intervention arm and 239 (12.2%) in the control arm. The marginal odds ratio was 0.71 (95% confidence interval (CI) 0.58 to 0.87; P=0.001) favouring the face mask intervention. The absolute risk difference was -3.2% (95% CI -5.2% to -1.3%; P<0.001). No statistically significant effect was found on self- reported (marginal odds ratio 1.07, 95% CI 0.58 to 1.98; P=0.82) or registered covid-19 infection (effect estimate and 95% CI not estimable owing to lack of events in the intervention arm). CONCLUSION: Wearing a surgical face mask in public spaces over 14 days reduces the risk of self-reported symptoms consistent with a respiratory infection, compared with not wearing a surgical face mask. TRIAL REGISTRATION: ClinicalTrials.gov NCT05690516.

Building on Strong Foundations: Deploying Enhanced Replicating Effective Programs for evidence-based prevention curriculum adaptation.

Schools frequently adopt new interventions for each new public health issue, but this is both time- and resource-intensive. Adversity exposure is an example of a pervasive public health issue that emerged during Coronavirus Disease 2019 (COVID-19) with notable consequences, including an elevated risk of developing substance use disorders and mental illnesses. Adapting existing, universal, evidence-based interventions, such as the Michigan Model for HealthTM (MMH), by incorporating trauma-sensitive content is a promising approach to meet this need. We examined critical steps in promoting MMH adaptability as part of the Enhanced REP (Replicating Effective Programs) implementation strategy during the COVID-19 pandemic. We share usability testing from the 2020 to 2021 school year and describe how we apply the results to inform the group randomized trial pilot study. We applied key steps from implementation adaptation frameworks to integrate trauma-sensitive content as COVID-19 unfolded, documenting the process through field notes. We conducted initial usability testing with two teachers via interviews and used a rapid qualitative analysis approach. We conducted member checking by sharing the information with two health coordinators to validate results and inform additional curriculum refinement. We developed an adapted MMH curriculum to include trauma-sensitive content, with adaptations primarily centered on adding content, tailoring content, substituting content, and repeating/reinforcing elements across units. We designed adaptations to retain the core functional elements of MMH. Building foundational relationships and infrastructure supports opportunities to user-test intervention materials for Enhanced REP that enhance utility and relevance for populations that would most benefit. Enhanced REP is a promising strategy to use an existing evidence-based intervention to meet better the needs of youth exposed to adversity. Building on the foundations of existing evidence-based interventions, is vital to implementation success and achieving desired public health outcomes.

Schools frequently adopt new interventions for each new public health issue that may or may not be evidence-based. Concentrating efforts on supporting the effective implementation of existing, widely adopted evidence-based interventions (EBIs) in schools is an efficient and effective way to achieve their public health impact and reduce implementer overload. We systematically adapted an EBI, the Michigan Model for HealthTM, to incorporate trauma-sensitive content and pilot-tested the materials with two health teachers using pre-/post-interviews to gather feedback for refinement. The implementation support professionals­regional school health coordinators­provided further insight and validation of teacher feedback on adaptations. The adaptations developed focused on maintaining the core functions that make the curriculum effective. We learned that the foundational relationships and implementation infrastructure were central to testing intervention materials in a way that would enhance utility and relevance for the student population that would most benefit. Leveraging available infrastructure and existing collaborations are vital to implementation success and achieving desired public health outcomes.

Povidone-iodine functionalized nanofibers are prophylactic and protect against dissemination of SARS-CoV-2 infection.

The novel personal protection equipment based on a face mask equipped with a nanofiber filter functionalized with povidone iodine has been developed and tested in a clinical trial. This nanofiber filter was characterized with a low flow resistance and, thus, allowed comfortable breathing. The performed study proved that the novel nanofiber filter with incorporated povidone-iodine was characterized with a slow release of iodine which minimized side effects but kept disinfection efficiency. Our clinical study performed on 207 positively tested SARS-CoV-2 patients wearing the PPE for 4-8 hours daily for 1 to 4 days has shown that even the iodine amount as low as 0.00028 ppm was sufficient to significantly decrease the reproduction number and, very importantly, to protect against severe course of disease.

Assessment and design of filters and masks against COVID-19 via modeling and simulations.

This study aimed to evaluate and design masks against viruses, especially SARS-CoV-2 associated with COVID-19. A continuum filtration model was developed where the rate of particle deposition and "sticking" on the filter fibers is a critical term in the mass transfer, together with permeation velocity, filter porosity, tortuosity, and Brownian diffusion. CFD simulations of the airflow during respiration lead to the recommendation that the filter permeability should be above 4 × 10-11 m2 to direct the airflow for effectiveness against virus particles; otherwise, low filter permeabilities cause the unfiltered air to flow preferentially through the leak gaps between the mask and the headform. Different mask filters with microstructural and geometry data from the literature are assessed via filtration simulations for breathability and filtration efficiency. The results demonstrate that a surgical mask of 25% porosity, pore size of 150 µm and permeability of 4.4 × 10-11 m2 can achieve 100% minimum efficiency while demonstrating high breathability, complying with the criteria of FFP3, N95, and surgical Class II and IIR masks. Selected cotton and synthetic cloths as well as electrospun fiber layers are predicted to comply with FFP2, N95, and surgical mask Class II and IIR standards.

Sudden Sensorineural Hearing Loss Before COVID-19, During COVID-19, and After Inactivated Vaccination: Experience From a Tertiary Referral Center in China.

OBJECTIVE: The purpose of this study was to investigate the incidence rate and audiological characteristics of sudden sensorineural hearing loss (SSHL) before the COVID-19 pandemic, during the COVID-19 pandemic, and after inactivated vaccination, and to analyze whether the novel coronavirus or inactivated vaccination have an impact on hearing loss. MATERIALS AND METHODS: The clinical data of all patients who visited the hospital in July 2019 (before pandemic), July 2020 (during pandemic) and July 2021 (after the inactivated vaccination at least the first basic dose of COVID-19 vaccination) were retrospective analyzed. All patients diagnosed with sudden sensorineural hearing loss in these three periods were screened, and their incidence rate, hearing characteristics, and prognosis were compared. RESULTS: Overall, the incidence rates of sudden hearing loss in July 2019, July 2020, and July 2021 were 0.59, 0.60, and 0.52% (25 of 4225, 20 of 3322, 28 of 5432), respectively, without significant difference ( χ2 = 0.372, p = 0.830). A significant difference was noted in the incidence of hypertension ( p = 0.02), whereas no significant difference was noted in age ( p = 0.591, p = 0.66), sex ( p = 0.19, p = 0.08), main symptoms ( p = 0.18, p = 0.15), side ( p = 0.483, p = 0.89), audiogram shape ( p = 0.56, p = 0.989), average hearing threshold of affected frequency ( p = 0.81, p = 0.89), average hearing threshold of normal ear affected frequency ( p = 0.65, p = 0.68), average hearing threshold of affected frequency after treatment ( p = 0.49, p = 0.38), days between symptoms onset and hospital visit ( p = 0.62, p = 0.85), treatment plan ( p = 0.551, p = 0.474), and effectiveness ( p = 0.104, p = 0.050). CONCLUSION: Our study failed to find a correlation between the novel coronavirus pandemic and inactivated vaccination and SSHL, and there was no direct evidence supporting that COVID-19 or inactivated vaccination had an impact on the incidence rate and prognosis of SSHL patients.

Prospects and Challenges in Developing mRNA Vaccines for Infectious Diseases and Oncogenic Viruses.

mRNA vaccines have emerged as an optimistic technological platform for vaccine innovation in this new scientific era. mRNA vaccines have dramatically altered the domain of vaccinology by offering a versatile and rapid approach to combating infectious diseases and virus-induced cancers. Clinical trials have demonstrated efficacy rates of 94-95% in preventing COVID-19, and mRNA vaccines have been increasingly recognized as a powerful vaccine platform. Although mRNA vaccines have played an essential role in the COVID-19 pandemic, they still have several limitations; their instability and degradation affect their storage, delivery, and over-all efficiency. mRNA is typically enclosed in a transport mechanism to facilitate its entry into the target cell because it is an unstable and negatively charged molecule. For instance, mRNA that is given using lipid-nanoparticle-based vaccine delivery systems (LNPs) solely enters cells through endocytosis, establishing an endosome without damaging the cell membrane. The COVID-19 pandemic has accelerated the development of mRNA vaccine platforms used to treat and prevent several infectious diseases. This technology has the potential to change the future course of the disease by providing a safe and effective way to combat infectious diseases and cancer. A single-stranded genetic sequence found in mRNA vaccines instructs host cells to produce proteins inside ribosomes to elicit immunological responses and prepare the immune system to fight infections or cancer cells. The potential applications of mRNA vaccine technology are vast and can lead to the development of a preferred vaccine pattern. As a result, a new generation of vaccinations has gradually gained popularity and access to the general population. To adapt the design of an antigen, and even combine sequences from different variations in response to new changes in the viral genome, mRNA vaccines may be used. Current mRNA vaccines provide adequate safety and protection, but the duration of that protection can only be determined if further clinical research is conducted.

A measles-vectored vaccine candidate expressing prefusion-stabilized SARS-CoV-2 spike protein brought to phase I/II clinical trials: protection of African green monkeys from COVID-19 disease.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged at the end of 2019 and is responsible for the largest human pandemic in 100 years. Thirty-four vaccines are currently approved for use worldwide, and approximately 67% of the world population has received a complete primary series of one, yet countries are dealing with new waves of infections, variant viruses continue to emerge, and breakthrough infections are frequent secondary to waning immunity. Here, we evaluate a measles virus (MV)-vectored vaccine expressing a stabilized prefusion SARS-CoV-2 spike (S) protein (MV-ATU3-S2PΔF2A; V591) with demonstrated immunogenicity in mouse models (see companion article [J. Brunet, Z. Choucha, M. Gransagne, H. Tabbal, M.-W. Ku et al., J Virol 98:e01693-23, 2024, https://doi.org/10.1128/jvi.01693-23]) in an established African green monkey model of disease. Animals were vaccinated with V591 or the control vaccine (an equivalent MV-vectored vaccine with an irrelevant antigen) intramuscularly using a prime/boost schedule, followed by challenge with an early pandemic isolate of SARS-CoV-2 at 56 days post-vaccination. Pre-challenge, only V591-vaccinated animals developed S-specific antibodies that had virus-neutralizing activity as well as S-specific T cells. Following the challenge, V591-vaccinated animals had lower infectious virus and viral (v) RNA loads in mucosal secretions and stopped shedding virus in these secretions earlier. vRNA loads were lower in these animals in respiratory and gastrointestinal tract tissues at necropsy. This correlated with a lower disease burden in the lungs as quantified by PET/CT at early and late time points post-challenge and by pathological analysis at necropsy.IMPORTANCESevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the largest human pandemic in 100 years. Even though vaccines are currently available, countries are dealing with new waves of infections, variant viruses continue to emerge, breakthrough infections are frequent, and vaccine hesitancy persists. This study uses a safe and effective measles vaccine as a platform for vaccination against SARS-CoV-2. The candidate vaccine was used to vaccinate African green monkeys (AGMs). All vaccinated AGMs developed robust antigen-specific immune responses. After challenge, these AGMs produced less virus in mucosal secretions, for a shorter period, and had a reduced disease burden in the lungs compared to control animals. At necropsy, lower levels of viral RNA were detected in tissue samples from vaccinated animals, and the lungs of these animals lacked the histologic hallmarks of SARS-CoV-2 disease observed exclusively in the control AGMs.

Review: N1-methyl-pseudouridine (m1Ψ): Friend or foe of cancer?

Due to the health emergency created by SARS-CoV-2, the virus that causes the COVID-19 disease, the rapid implementation of a new vaccine technology was necessary. mRNA vaccines, being one of the cutting-edge new technologies, attracted significant interest and offered a lot of hope. The potential of these vaccines in preventing admission to hospitals and serious illness in people with comorbidities has recently been called into question due to the vaccines' rapidly waning immunity. Mounting evidence indicates that these vaccines, like many others, do not generate sterilizing immunity, leaving people vulnerable to recurrent infections. Additionally, it has been discovered that the mRNA vaccines inhibit essential immunological pathways, thus impairing early interferon signaling. Within the framework of COVID-19 vaccination, this inhibition ensures an appropriate spike protein synthesis and a reduced immune activation. Evidence is provided that adding 100 % of N1-methyl-pseudouridine (m1Ψ) to the mRNA vaccine in a melanoma model stimulated cancer growth and metastasis, while non-modified mRNA vaccines induced opposite results, thus suggesting that COVID-19 mRNA vaccines could aid cancer development. Based on this compelling evidence, we suggest that future clinical trials for cancers or infectious diseases should not use mRNA vaccines with a 100 % m1Ψ modification, but rather ones with the lower percentage of m1Ψ modification to avoid immune suppression.

The Safety and Efficacy of a "No Touch" Abortion Program Implemented in the Greater Toronto Area During the COVID-19 Pandemic.

OBJECTIVES: To evaluate the safety and efficacy of first-trimester "No Touch" medication abortion programs at 2 clinics in Toronto, Ontario during their early implementation in response to the COVID-19 pandemic. METHODS: This retrospective study included all patients who underwent virtual consultation for mifepristone-misoprostol medication abortion between April 2020-August 2022 at 2 reproductive health clinics. In response to the pandemic, "No Touch" abortion protocols have been developed that align with the Canadian Protocol for the Provision of Medical Abortion via Telemedicine. Records were reviewed for demographic information, clinical course, investigations required, confirmation of complete abortion and adverse events. The primary outcome was complete medication abortion, defined as expulsion of the pregnancy without requiring uterine aspiration. RESULTS: A total of 277 patients had abortions initiated in the "No Touch" or "Low Touch" care pathways and had sufficient follow-up to determine outcomes. Of these patients, 92.8% (95% CI 89.7%-95.8%) had a complete medication abortion (n = 257) and 76.1% (n = 159) remained "No Touch" throughout their care. Investigations were performed for 102 participants before or after their abortion, classifying them as "Low Touch". Nineteen patients (6.9%) underwent uterine aspiration. The rate of adverse events was low, with 1 case of a missed ectopic pregnancy and 1 patient requiring hospitalization for endometritis. CONCLUSIONS: "No Touch" provision of mifepristone-misoprostol medication abortion care was safe and effective with outcomes comparable to previous studies. These results provide evidence for the efficacy and safety of a "No Touch" approach in the Canadian context, which has the potential to reduce barriers to accessing abortion care.

Aerosol-generating procedures and associated control/mitigation measures: Position paper from the Canadian Dental Hygienists Association and the American Dental Hygienists' Association.

Background: Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosolgenerating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the evidence of the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry. Methods: The authors searched 6 databases-MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar-for relevant scientific evidence published between January 2012 and December 2022 to answer 6 research questions about the risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols. Results: A total of 78 studies fulfilled the eligibility criteria. The literature on the risk of infection transmission including SARS-CoV-2 between dental hygienists and their patients is limited. Although several mouthrinses are effective in reducing bacterial contaminations in aerosols, their effectiveness against SARS-CoV-2 is also limited. The combined use of eyewear, masks, and face shields is effective in preventing contamination of the facial and nasal region while performing AGPs. High-volume evacuation with or without an intraoral suction, low-volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories is effective in limiting the spread of aerosols. Discussion and Conclusion: Aerosols produced during clinical procedures can pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence will ensure greater patient and provider safety in oral health settings. More studies in oral health clinical environments would shape future practices and protocols, ultimately to ensure the delivery of safe clinical care.

Contexte: Depuis l'éclosion de la COVID-19, la façon de réduire le risque de propagation de virus et d'autres microorganismes tout en effectuant des interventions générant des aérosols (IGA) est devenue un enjeu complexe au sein des communautés de la médecine dentaire et de l'hygiène dentaire. L'objectif de cet exposé de position est de résumer les données probantes de l'efficacité des diverses méthodes d'atténuation utilisées pour réduire le risque de transmission des infections pendant les IGA en médecine dentaire. Méthodes: Les auteurs ont effectué des recherches dans MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library et Google Scholar pour trouver des preuves scientifiques pertinentes publiées entre janvier 2012 et décembre 2022 afin de répondre à 6 questions de recherche sur le risque de transmission, les méthodes, les dispositifs et l'équipement de protection individuelle (EPI) utilisés pour réduire le contact avec les agents pathogènes microbiens et limiter la propagation des aérosols. Résultats: Au total, 78 études ont satisfait aux critères d'admissibilité. La documentation est limitée en ce qui concerne le risque de transmission des infections, y compris le SRAS-CoV-2, entre les hygiénistes dentaires et leurs patients. Bien que plusieurs rince-bouches soient efficaces pour réduire la contamination bactérienne dans les aérosols, leur efficacité contre le SRAS-CoV-2 est limitée. L'utilisation combinée de lunettes, de masques et d'écrans faciaux est efficace pour prévenir la contamination de la région faciale et nasale lors de l'exécution d'IGA. L'évacuation à volume élevé avec ou sans aspiration intraorale, l'évacuation à faible volume, l'aspirateur de salive et la digue dentaire en caoutchouc (le cas échéant) ont démontré une efficacité à réduire la transmission des aérosols au-delà du site de production. Enfin, la combinaison appropriée de ventilation et de filtration dans les salles de traitement dentaire permet de limiter efficacement la propagation des aérosols. Discussion et conclusion: Les aérosols produits lors des interventions cliniques peuvent présenter un risque de transmission des infections entre les hygiénistes dentaires et leurs patients. La mise en oeuvre de pratiques appuyées par les données probantes disponibles assurera une plus grande sécurité des patients et des prestataires dans les milieux de santé buccodentaire. Un plus grand nombre d'études dans les environnements cliniques de santé buccodentaire permettrait de façonner les pratiques et les protocoles futurs dans le but d'assurer la prestation sécuritaire des soins cliniques.

Knowledge, attitudes, and practices toward COVID-19 and its prevention among medical and dental students in an educational institution in Telangana.

BACKGROUND: Coronavirus disease 2019 (COVID-19) emerged as a global pandemic, threatening millions of lives worldwide. Everyone was overwhelmed by the plethora of information from different sources, creating confusion, misconceptions, and panic in the community. AIMS: This study aimed to estimate the knowledge, attitudes, and practices (KAP) among medical and dental students toward COVID-19 and to identify factors influencing them. MATERIALS AND METHODS: A cross-sectional study was conducted among undergraduate students enrolled in MBBS and BDS courses, and KAP scores were calculated using a self-administered questionnaire. The statistical analysis was done by unpaired t test and one-way analysis of variance. RESULTS: MBBS students had higher KAP scores when compared with BDS students. Knowledge gaps were discovered in the areas of COVID-19 transmission through blood, World Health Organization (WHO)-designated variants of concern, disinfectant usage, and mandatory vaccination. A majority (91.33%) of the students had a positive attitude toward COVID-19. Better knowledge and practice scores were significantly associated with vaccinated students and those who trusted government website resources. CONCLUSION: Curriculum modifications and creative teaching strategies can fill the lacunae in the KAP scores. Medical and dental students, as torchbearers of the healthcare fraternity, can play a critical role in raising awareness during public health emergencies.

Ayush [Indian System of Medicines] Prophylaxis Against COVID-19: A Living Systematic Review and Meta-Analysis (Second Update).

Background: Ayush (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy) system of medicine has been extensively used in India for the prevention and management of coronavirus disease 2019 (COVID-19). The present report is the second update of a living systematic review and meta-analysis and has been intended to assess the preventive potential and safety of Ayush drugs against COVID-19. Methods: A search of databases such as PubMed, the Cochrane central register of controlled trials, the World Health Organization (WHO) COVID-19 database, the clinical trial registry-India, the AYUSH research portal, and preprint repositories was performed till March 1, 2023. Randomized controlled trials or analytical observational studies were included. Incidences of COVID-19 infections and mortality were taken as primary outcome measures; and symptomatic severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection, incidences of hospital admissions, and adverse events were taken as secondary outcomes. The risk of bias was evaluated by version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2) and the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tool. Data were synthesized through the RevMan 5.4 tool, and the certainty of the evidence was ranked through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Out of 2350 articles, 15 studies were included in the review. The pooled estimate of Guduchi [Tinospora cordifolia (Thunb.) Miers], Chyawanprasha, and Ayuraksha kit was obtained. Meta-analysis of the data suggested that Guduchi may reduce the incidences of COVID-19 infections (risk ratio [RR]: 0.67 [95% confidence interval, CI: 0.48-0.95]) and the symptom development among the infected (RR: 0.88 [95% CI: 0.73-1.08]), however, no change was observed in hospital admissions (RR: 0.96 [95% CI: 0.20-4.53]). It is uncertain that Chyawanprasha reduces the incidence of COVID-19 infection (RR: 0.28; [95% CI: 0.07-1.08]). Ayuraksha kit as chemoprophylaxis may reduce the incidences of COVID-19 infections (RR: 0.49; [95% CI: 0.32-0.77]). The certainty of the evidence was low to moderate mainly due to the serious risk of bias. Conclusion: Prophylactic use of Ayush medicines for populations at risk may help to prevent COVID-19 infection by reducing incidence and severity. However, considering the certainty and fewer studies, high-quality studies are still desired to confirm the efficacy and safety of Ayush chemoprophylaxis for COVID-19. Nevertheless, this update will serve as a torchbearer for policymakers, physicians, and other stakeholders for their decision-making through evidence-based medicine.

Re-inventing protection in a post-pandemic world: A new aerodynamic endonasal filtration technology.

Is there a "missing device" for respiratory personal protection? Does it exist an easy-to-use device, allowing extensive use in everyday settings by the population, maximizing tolerability and low visual and physical invasiveness protecting from a wide range of threats including airborne pathogens, hence including the particle range of fine and ultrafine particles? Looking at the recent past, in the urgency of finding ready-to-use solutions for the respiratory protection of the population during the outbreak of the SARS-CoV-2 pandemic, devices for occupational safety have been used, such as filtering face masks. These are devices intended for workers operating during work shifts in environments characterized by potential high risk, known a priori, often directly sensible; this makes wearers motivated to tolerate discomfort for a given period to face a localized risk, and safety managers determined to supervise compliance with usage specifications. Their use by general population has implied known shortcomings, such as weak compatibility with relational work and activities, low tolerability during prolonged use, low compliance with the proper use of the device, all of this lessening actual protection. The need for a new perspective has emerged, targeting effectiveness in whole daily life, rather than punctual efficacy. Nasal filters are promising candidates to protect individuals throughout the day during the most varied activities, but they lack a systematic definition as a device and as a product; it follows that the high complexity needed to reach an effective performance envelop is generally underestimated. By reviewing available literature, the present paper draws on the experience from the pandemic and infers systematic product specifications and characterization methods for a new, effective personal respiratory protection device; these specifications are compared with the stringent constraints associated with the endonasal applications and, based on air filtration state of the art, quantifies the need for technology disruption and outlining possible new development paths.

Pathogen evolution, prevention/control strategy and clinical features of COVID-19: experiences from China.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported at the end of 2019 as a worldwide health concern causing a pandemic of unusual viral pneumonia and many other organ damages, which was defined by the World Health Organization as coronavirus disease 2019 (COVID-19). The pandemic is considered a significant threat to global public health till now. In this review, we have summarized the lessons learnt during the emergence and spread of SARS-CoV-2, including its prototype and variants. The overall clinical features of variants of concern (VOC), heterogeneity in the clinical manifestations, radiology and pathology of COVID-19 patients are also discussed, along with advances in therapeutic agents.