Designing a Wastewater-Based Epidemiology Study at the U.S. Air Force Academy: Using Severe Acute Respiratory Syndrome Coronavirus 2 to Test a Sentinel System for Early Disease Outbreak Detection.

INTRODUCTION: The presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in wastewater has been proposed as a sentinel surveillance epidemiological tool for detection of infectious disease at a community level and as a complementary approach to syndromic surveillance of infectious disease outbreaks. We have designed a study to test the presence and quantity of SARS-CoV2, the virus responsible for COVID19, in the wastewater treatment facility (WWTF) of the U.S. Air Force Academy. MATERIALS AND METHODS: Wastewater samples were tested in the laboratory to quantify the amount of SARS-CoV2 RNA using reverse transcription-quantitative polymerase chain reaction. Raw SARS-CoV2 viral titer in wastewater was normalized to the viral titer of a fecal marker, pepper mild mottle virus, to correct for dilutions. Temporal and spatial trends of COVID19 were analyzed. Furthermore, we compared wastewater analysis results against clinical data to assist public health decisions. RESULTS: Preliminary data suggest that wastewater analysis can provide temporal and spatial trends of COVID19. The geographically discrete WWTF at the U.S. Air Force suggests that wastewater testing is a useful approach to developing a comprehensive sentinel surveillance system. CONCLUSIONS: Together with ongoing syndromic surveillance data, this proof-of-concept study seeks to determine whether early detection of SARS-CoV2 in a closed system WWTF correlates to changes in community and clinically reported COVID19. The well-documented population served by the geographically discrete WWTF at the U.S. Air Force Academy may serve to better elucidate the adjunctive role of wastewater testing in a comprehensive surveillance system. These results may be of particular interest to the DoD and local commanders given the WWTFs under their immediate control and the information that these studies may provide in support of operational readiness through early detection of disease outbreaks.

Favipiravir in Patients With Early Mild-to-moderate Coronavirus Disease 2019 (COVID-19): A Randomized Controlled Trial.

BACKGROUND: Despite vaccination, many remain vulnerable to coronavirus disease 2019 (COVID-19) and its complications. Oral antivirals to prevent COVID-19 progression are vital. Based on perceived potency and clinical efficacy, favipiravir is widely used to treat COVID-19. Evidence from large randomized controlled trials (RCT) is lacking. METHODS: In this multicenter double-blinded placebo-controlled RCT, adults with early mild-to-moderate COVID-19 were 1:1 randomized to favipiravir or placebo. The study evaluated time to sustained clinical recovery (TT-SCR), COVID-19 progression, and cessation of viral shedding. RESULTS: Of 1187 analyzed patients across 40 centers, 83.3% were Hispanic, 89.0% unvaccinated, 70.3% severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seronegative, and 77.8% had risk factors for COVID-19 progression. The median time from symptom presentation and from positive test to randomization was 3 and 2 days, respectively. There was no difference in TT-SCR (median of 7 days for both groups; P = .80), COVID-19 progression [11 patients each (1.9% vs 1.8%); P = .96], time to undetectable virus (median = 6 days, 95% confidence interval [CI] [6-8] vs 7 days, 95% CI [6-9]), or in undetectable virus by end of therapy (73.4% vs 72.3%; P = .94). Outcomes were consistent across the analyzed sub-groups. Adverse events were observed in 13.8% and 14.8% of favipiravir-treated and placebo-treated subjects, respectively. Uric acid elevation was more frequent among favipiravir-treated subjects (19.9% vs 2.8%). CONCLUSIONS: Favipiravir was well tolerated but lacked efficacy in TT-SCR, progression to severe COVID-19, or cessation of viral shedding and should not be used to treat patients with COVID-19. (Supported by Appili Therapeutics). CLINICAL TRIALS REGISTRATION: NCT04600895.

Tuberculosis induced changes to the osseous cranial base and its potential effect on hearing.

Our prior work suggested that petro-occipital fissure (POF) ossification may be altered in clinicopathologies of the cranial base such as hearing loss (Balboni et al., 2005). Here we demonstrate an accelerated and statistically significant ossification of the POF and cochlear aqueduct (CA) in a historical population of patients diagnosed with tuberculosis (TB). While a number of studies have sought to reduce the importance of the POF/CA to hearing, given its anatomical location, evolutionary conservation across mammals and the mounting data linking morphological changes of the POF/CA to the temporal onset of hearing loss and tinnitus, it is becoming difficult to maintain that its function is not related to inner ear homeostasis.

Assessing age-related ossification of the petro-occipital fissure: laying the foundation for understanding the clinicopathologies of the cranial base.

The petro-occipital fissure (POF) lies within a critical interface of cranial growth and development in the posterior cranial fossa. The relationships between skeletal and soft tissues make this region especially important for examining biomechanical and basic biologic forces that may mold the cranial base and contribute to significant clinicopathologies associated with the structures located near the POF. Therefore, this study investigates the POF in adults in both preserved human cadavers and dried crania in order to determine if developmental changes can be observed and, if so, their value in age assessment as a model system for describing normal morphogenesis of the POF. This study demonstrates that tissue within the POF undergoes characteristic changes in ossification with age, the onset of which is considerably later than that of other synchondroses of the cranial base. Statistically, there is a moderate to strong correlation between age and stage of ossification within the POF. Further, male crania were observed to reach greater degrees of ossification at a younger age than female crania and that individual asymmetry in ossification of the tissue within the POF was not uncommon. An understanding of the basic temporal biological processes of the POF may yield insight into the development of clinicopathologies in this region of the cranial base.

Isolation of DNTNP, which encodes a potential nuclear protein that is expressed in the developing, dorsal neural tube.

We have performed a screen to identify genes expressed in a functionally significant anatomic region of the vertebrate dorsal neural tube, the dorsomedial roof of the third ventricle (DMRTV). The DMRTV includes the primordia of a series of circumventricular organs. The screen searched for genes preferentially expressed in the DMRTV of stage 18-25 chicken embryos, relative to their telencephala and ventral diencephalon. Through this screen, we have cloned a series of genes strongly expressed in the dorsal but not ventral neural tube. We describe here the first of these genes, DNTNP (dorsal neural tube nuclear protein). DNTNP is highly expressed in the dorsal regions of the diencephalon, the midbrain, the hindbrain, and the spinal neural tube in the chicken stage 18 embryo. Expression is also observed in the telencephalon, the branchial arches, the heart, and somites, but is absent from the presomitic mesoderm. The amino acid sequence of DNTNP reveals that it belongs to an uncharacterized protein family with at least two additional members. All the members of this family possess a basic region reminiscent of a nuclear localization signal (NLS). We demonstrate that the putative NLS of DNTNP can indeed direct nuclear localization of green fluorescent protein (GFP). The dorsal localization of DNTNP in the early embryonic central nervous system suggests roles for this molecule in specifying dorsal cell fates within the neural tube.