BCG as a game-changer to prevent the infection and severity of COVID-19 pandemic?

The impact of COVID-19 is changing with country wise and depend on universal immunization policies. COVID-19 badly affects countries that did not have universal immunization policies or having them only for the selective population of countries (highly prominent population) like Italy, USA, UK, Netherland, etc. Universal immunization of BCG can provide great protection against the COVID-19 infection because the BCG vaccine gives broad protection against respiratory infections. BCG vaccine induces expressions of the gene that are involved in the antiviral innate immune response against viral infections with long-term maintenance of BCG vaccine-induced cellular immunity. COVID-19 cases are reported very much less in the countries with universal BCG vaccination policies such as India, Afghanistan, Nepal, Bhutan, Bangladesh, Israel, Japan, etc. as compared to without BCG implemented countries such as the USA, Italy, Spain, Canada, UK, etc. BCG vaccine provides protection for 50-60 years of immunization, so the elderly population needs to be revaccinated with BCG. Several countries started clinical trials of the BCG vaccine for health care workers and elderly people. BCG can be uses as a prophylactic treatment until the availability of the COVID-19 vaccine.

Handling consumer vulnerability in e-commerce product images using machine learning.

Need: In recent years, secondhand products have received widespread attention, which has raised interest in them. The susceptibility issues that consumers encounter while buying online products in reference to the display images of the products are also not well researched. Motivation: Retailers employ clever tactics such as ratings, product reviews, etc., to establish a strong position thereby boosting their sales and profits which may have an indirect impact on the consumer purchase that was not aware of that retailer's behavior. This has led to the novel method that has been suggested in this work to address these issues. Proposed methodology: In this study, a handling method for reused product images based on user vulnerability in e-commerce websites has been developed. This method is called product image-based vulnerability detection (PIVD). The convolutional neural network is employed in three steps to identify the fraudulent dealer, enabling buyers to purchase goods with greater assurance and fewer damages. Summary: This work is suggested to boost consumers' confidence in order to address the issues they encounter when buying secondhand goods. Both image processing and machine learning approaches are utilized to find vulnerabilities. On evaluation, the proposed method attains an F1 score of 2.3% higher than CNN for different filter sizes, 4% higher than CNN-LSTM when the learning rate is set to 0.008, and 6% higher than CNN when dropout is 0.5.

Inflammatory BCG adenitis associated with immune reconstitution following allogeneic haematopoietic stem cell transplant in infancy.

We describe four cases of a localized, granulomatous reaction to BCG including ipsilateral painful, suppurative lymphadenopathy associated with donor immune reconstitution following allogeneic haematopoietic stem cell transplant performed in infancy and preceded by uneventful, routine BCG immunisation. The management of the inflammatory disease in these cases with surgery, antimycobacterial chemotherapy and steroids, is discussed.

Localization of estrogen receptor beta protein expression in adult human bone.

Evidence suggests that the newly described estrogen receptor beta (ER-beta) may be important for estrogen (17beta-estradiol) action on the skeleton, but its cellular localization in adult human bone requires clarification. We addressed this by using indirect immunoperoxidase with a novel affinity purified polyclonal antibody to human ER-beta, raised to hinge domain (D) sequences from the human receptor. Bone was demineralized in 20% EDTA and all biopsy specimens were formalin-fixed and wax-embedded. Vigorous retrieval was essential for ER-beta detection. In sections (5 microm) of benign prostate hyperplasia, used as positive control, clear nuclear immunoreactivity was seen in glandular epithelial cells, with a 1:500 dilution of ER-beta40. For bone sections, optimal antibody dilutions were 1:100-1:250. We found that in normal bone (from graft operations), in fracture callus from both men and women (>25 years old), pagetic bone, osteophytes, and secondary hyperparathyroid bone, all from older patients, ER-beta was expressed clearly in osteoclast nuclei, with little cytoplasmic immunoreactivity. Nuclear immunoreactivity was still prominent in osteoclasts, with antibody diluted 1:500, although it faded in other cells. Osteoblasts, in areas of active bone formation or bone remodeling, also expressed ER-beta, as did some osteocytes. However, hypertrophic chondrocytes were negative, unlike mesenchymal cells, adjacent to the osteogenesis. Megakaryocytes and some capillary blood vessels cells were receptor positive. All ER-beta expression was blocked totally by preincubation of antibody with antigen. We conclude that ER-beta is expressed in cells of osteoblast lineage and in osteoclasts. The latter appear relatively abundant in this receptor and this might provide a means for direct action of estrogen on osteoclasts.

Failure of anterior cruciate ligament reconstruction following calcification of the graft.

Anterior cruciate ligament (ACL) reconstruction is a commonplace orthopaedic procedure. It is most commonly performed using an autologous bone-patella tendon-bone graft, although other donor sites are also used. Failure of the graft can occur for a variety of reasons. We describe here failure of such an ACL reconstruction in a young man secondary to ectopic calcification of the graft, which led to excessive rigidity and its subsequent avulsion from the proximal attachment. This case illustrates the benefits of being able to reconstruct the ACL by more than one technique, which can be used if another method fails.

Colorectal patients and cardiac arrhythmias detected on the surgical high dependency unit.

INTRODUCTION: Surgical high dependency unit (SHDU) care is becoming an integral feature of colorectal surgical practice. Routine ECG monitoring is a feature of surgical care in this setting. The aim of this study was to determine the incidence and outcome of cardiac arrhythmias detected in an SHDU population of colorectal patients. PATIENTS AND METHODS: 226 patients over a 12 month period were admitted to a 6-bedded SHDU under the care of 3 colorectal surgeons. A total of 29 patients (13%) had significant arrhythmias on ECG monitoring (median age 74 years, range 35-88 years). Pre-existing ischaemic heart disease was present in 9 patients--colorectal cancer and inflammatory bowel disease accounted for the underlying problem in the majority of these patients. RESULTS: Equal numbers of supraventricular and ventricular arrhythmias were detected--atrial fibrillation being the most commonly detected abnormality. Therapeutic intervention (electrolyte correction and anti-arrhythmic agents) was required in 23 patients. One patient required DC shock for ventricular fibrillation. Seven patients were transferred to the heart care unit or intensive care unit to manage their cardiac problems. Two patients died as a result of their cardiac problem, 27 were discharged home alive--3 on long-term anti-arrhythmic therapy. CONCLUSIONS: The postoperative environment of colorectal patients has been radically altered by the introduction of the SHDU. If colorectal surgeons are to remain central to the postoperative care of their patients, all surgical staff will require training in the recognition and protocol prevention and management of cardiac arrhythmias. Certification of colorectal surgeons in advanced life support is more relevant to colorectal surgery than certification in trauma care.

Duration and method of tissue storage alters placental morphology - implications for clinical and research practice.

We assessed whether placental morphology is affected by placental storage before fixation. Fresh tissue from uncomplicated pregnancies (n = 10) was fixed immediately and further samples were stored dry, in PBS or culture medium for 24, 48 or 72 h at 4 °C. Placental morphology quantified using image analysis software found no difference in syncytial nuclear aggregates, cytokeratin 7, CD45 or Ki67 immunostaining irrespective of duration or mode of storage. The number of blood vessels per villus (CD31) was reduced in all conditions after 72 h (p < 0.05). Distal villous hypoplasia increased after 72 h (p < 0.05). Ideally, storage time should be minimised to ≤48 h prior to morphological or qualitative analysis.

A case of confined placental mosaicism with double trisomy associated with stillbirth.

We present a case of stillbirth in which the fetus was well grown and karyotypically normal, but the placenta was morphologically abnormal and had confined placental mosaicism (CPM) for a double trisomy of chromosomes 12 and 15. A compilation of published cases of CPM reveals that whilst approximately 80% of pregnancies progress normally, there is an association with abnormal placental morphology, intrauterine growth restriction, fetal abnormalities and stillbirth. This case highlights the potential adverse effects of CPM and the benefit of placental examination in determining the cause of stillbirth.

Bipartite anterior extraperitoneal teratoma: evidence for the embryological origins of teratomas?

Teratomas are thought to arise from totipotent primordial germ cells (PGCs) Dehner (1983) which may miss their target destination Moore and Persaud (1984). Teratomas can occur anywhere from the brain to the coccygeal area but are usually in the midline close to the embryological position of the gonadal ridges Bale (1984), Nguyen and Laberge (2000). We report a case of a bipartite anterior extraperitoneal teratoma. This is an unusual position for a teratoma, but one which may support the "missed target" theory of embryology.

Bronchoscopy and lung lavage induced bilateral pulmonary neutrophil influx and blood leukocytosis in dogs and monkeys.

Investigators have previously determined that repetitive lung washes attract neutrophils to the lungs. They ascribed this attraction to the release of chemotactic factors. Our studies demonstrate that lavage of one lobe of a lung attracts neutrophhils to unwashed lobes as well; therefore, the attraction of neutrophils cannot be entirely due to the local release of chemotactic agents. Further experiments showed that influx of neutrophils also occurred after bronchoscopy without lung lavage but not after the anesthesia alone. These studies suggest that the lungs have mechanisms that regulate and control neutrophil influx both locally and contralaterally. It is not yet clear whether the controlling mechanisms represent an integrated system in the control of leukocyte traffic through the lungs. In addition, lung lavage and bronchoscopy without lung lavage cause an increase in the blood leukocyte count, with an increase in the number of young neutrophil forms. Lung wash concentrates cause a dramatic increase in the number of blood leukocytes when instilled into a bronchus. These data indicate that lungs contain a material that can stimulate the bone marrow to release leukocytes from its reserves.

Role of anaerobes in acute pelvic inflammatory disease.

Pouch of Douglas aspirates were collected from 50 women with history and examination suggestive of acute pelvic inflammatory disease (PID) and 20 healthy women admitted for tubal ligation served as control. A total of 57 microorganisms were isolated from 37 patients out of 50 in study group. Of 37 positive cultures 21(56.7%) were monomicrobial and 16(43.2%) were polymicrobial. Most common symptom in study group was lower abdominal pain (90%), vaginal discharge (70%) and irregular bleeding (40%) and 30% patients had history of intrauterine contraceptive device (IUCD) implantation. The predominant aerobic isolates were Escherichia coli, Coagulase Negative Staphylococcus (CONS), Staphylococcus aureus, Klebsiella pneumoniae while common anaerobes were Bacteroides fragilis, Prevotella melaninogenica, Fusobacterium nucleatum and Peptostreptococcus spp. Our study shows that cefotaxime, cefuroxime and gentamicin may be used for gram negative aerobic bacilli; cloxacillin, cephaloridine and erythromycin for aerobic gram positive cocci and amikacin and ceftazidime for Pseudomonas aeruginosa. Thus for optimum therapy of acute PID it is beneficial to keep in mind major conceptual changes and therapeutic realities that have influenced current understanding of acute PID and have affected the choice of therapy.

Local regulation of collateral ventilation by oxygen and carbon dioxide.

The effects of changes in CO2 and O2 on the mechanics of collateral ventilation were studied in anesthetized paralyzed dogs. A doublelumen catheter was wedged into a peripheral airway obstructing a segment of lung distal to the catheter. Through one lumen of the catheter, air, 5% CO2 in air, 10% CO2 in air, 5% O2 in N2, or 5% CO2 in N2 was infused at a constant flow (V). Pressure (Ps) was monitored through the other lumen. At functional residual capacity the resistance to collateral flor Rcoll = Ps/V. When V was interrrupted , the time for Ps to fall 63% was defined as the time constant for collateral ventilation, Tcoll. The effective compliance (Cs') = Tcoll/Rcoll. When air was replaced by 5% CO2, Rcoll fell 46.3% (+/- SE 2.8) and Tcoll fell 41.5% (+/- SE 3.0). When the CO2 concentration was increased from 5% to 10%, Rcoll fell an additional 9.2% (+/- SE 2.2) and Tcoll fell an additional 5.1% (+/- SE 4.4). When air was replaced by 5% O2 in N2, Rcoll rose 36.6% (+/- SE 6.0) and Tcoll rose 13.6% (+/- SE 10.5). No significant changes in Cs' were noted. We conclude that varying concentrations of CO2 and O2 provide potent mechanisms for the control of collateral ventillation which may be of importance in the regulation of ventillation perfusion relationships at the local level.

Effect of transpulmonary and vascular pressures on rate of pulmonary edema formation.

The effect of transpulmonary pressure (Ptp) on rate of extravascular fluid accumulation in isolated canine left lower lobes perfused at constant vascular pressures was investigated. Changes in rate of extravascular fluid accumulation were estimated by changes in rate of slow weight gain. Mean inflow pressure (Ppa) was constant at 34 cmH2O. Mean outflow pressure (Ppv) was constant at either 27.2 cmH2O or 13.6 cmH2O. When increasing Ptp is associated with a derecruitment of vascular beds as the lung changes from predominantly zone III toward zone II, or zone I, there is a decrease in rate of weight gain. When increasing Ptp is not associated with a derecruitment of vascular beds, it is impossible on the basis of these experiments to predict the change in rate of weight gain.

Effects on body position and cholinergic blockade on mechanics of collateral ventilation.

We studied the effects of position and cholinergic blockade on the mechanics of collateral ventilation in anesthetized paralyzed dogs. Resistance to collateral flow (Rcoll) is higher when an obstructed segment is dependent than when it is nondependent. Decreases of Rcoll in response to the local infusion of low oxygen mixtures are greater in dependent regions. We conclude that 1) changes in position affect Rcoll directly through local changes in lung volume related to the gradient of pleural pressure; 2) responses of collateral channels to local concentrations of CO2 and O2 are determined by ventilation perfusion relationships, which vary at different heights in the lung; and 3) resting cholinergic tone in the anesthetized dog varies at different heights in the lung.

Reduction of intercellular adhesiveness of chick heart cells by herpes simplex viruses 1 and 2.

Infection with herpes simplex viruses type 1 or 2 prevented the aggregation of 7-day-old chick heart cells into smooth, spheroidal, spontaneously beating aggregates. Virus infection also caused a loosening of peripheral cells in aggregates formed from initially uninfected cells. Measurements of rate of attachment of labelled single heart cells to a monolayer of like cells (homotypic), to HEp-2 cells (heterotypic), or to plastic substrata (nonspecific adhesion) indicated that virus infection caused a significant but differential loss of homotypic and nonspecific adhesiveness, but no alteration in heterotypic attachment rates. These observations indicate that those cells surface changes induced by viruses which are related to cell adhesion can be quantified by techniques measuring attachment rates.

Needle biopsy for muscle chemistry.

Needle biopsy can readily provide samples of human skeletal muscle for biochemical analysis. Muscle metabolites are measured by enzymic microanalytical techniques and electrolytes by neutron-activation analysis. This paper summarises the methods of analysis, gives the normal ranges for muscle contents of metabolites and electrolytes, and reviews the reported changes in a number of neuromuscular and metabolic disorders. Muscle is a fairly homogeneous tissue in health, but replacement with fat and fibrous tissue in myopathies causes error in analyses unless metabolites are referred to a reliable standard. It is recommended that needle-biopsy samples to be freeze-dried and dissected to remove connective tissue before analysis. Total creatine (phosphorylcreatine+free creatine) total adenosine+inosine nucleotides, and potassium and phosphorus separtely correlated very highly with sample dry weight after dissection, suggesting that these may be used as standards. When assessing whether a given metabolite is present in an abnormal amount, it is probaby advisable to check the content with reference to more than one standard, since one or more of these may be changed in disease.

Size of the pool of alveolar neutrophils in normal rabbit lungs.

Morphometric methods and two unique characteristics of neutrophils enabled us to measure the size of the pool of neutrophils in alveoli of rabbit lungs. Rabbit lungs contained an estimated 6.11 x 10(4) alveolar neutrophils/g wet wt of lungs, and 9.57 x 10(5) alveolar neutrophils/rabbit. Lung lavage was successful in removing an average of 42.2% of the neutrophils in the air containing spaces of the lungs. An average of 2.5 +/- 3.5 (SD)% of the cells in the lung washes were neutrophils, but an average of 10.23 +/- 5.0 (SD)% of the cells that were free in the alveolus were neutrophils. Studies of the interaction of alveolar macrophages and neutrophils in vitro showed that neither cell phagocytoses or destroys the other in significant quantities; however, alveolar macrophages containing neutrophils have been observed.

Changes in collateral ventilation with increased vascular pressure and edema formation.

To test the hypothesis that development of hemodynamic edema results in decreased collateral ventilation, we rapidly volume-expanded anesthetized dogs with volumes equivalent to 10 (n = 5) and 15% (n = 5) of body weight. We measured collateral resistance (Rcoll), pulmonary arterial pressure, and left ventricular end-diastolic pressure before, during, and for 1-2 h after the infusion. Lungs were subsequently processed for microscopic examination and measurement of extravascular lung water content. During the infusion, Rcoll increased modestly independent of the fluid-infusion rate or the rate of increase in vascular pressures. After the infusion, Rcoll continued to increase to maximum levels 2-33 times base line even though pressures decreased dramatically. At the end of the experiment, Rcoll returned to base line in one dog and was 3-15 times base line in the other dogs. These changes bore no relationship to the severity of edema formation. Until alveolar flooding occurs, accumulation of lung interstitial fluid and changes in collateral ventilation appear to be coincident events rather than causally related variables.