During the current COVID-19 pandemic, different methods have been used to evaluate patients suspected with infection of SARS-CoV-2. In this study, we evaluate the longevity of saliva and dry swab samples to retain SARS-CoV-2 for storage and transport at different environmental settings. Our results show that at ambient temperature of 20°C, SARS-CoV-2 RNA remains stable for up to 9 days giving a long span of time for transport and storage without compromising clinical results. Additionally, this study demonstrates that sali­­­va and dry swabs specimens can also be stored at -20°C and +4°C for up to 26 days without affecting RT-qPCR results. Our data is relevant for low-and middle-income countries, which have limited access to rapid refrigerated transport and storage of samples representing an economical alternative. Finally, our study demonstrates that dry swabs provide clear advantages over using transport medium.

Background: Telehealth is delivering health care services remote from health-care facilities using telecommunications. Egypt is aiming for Universal Health Coverage; this increases the demand of telehealth in routine health services. Objective: to measure the awareness of telehealth health care workers of primary health care units and to evaluate the effect of an orientation program on primary health care workers’ awareness and acceptance of application of telehealth. Methodology: This was an intervention study among health care workers. A self-administrated valid questionnaire for health care workers was designed, the questionnaire consists of different domains of knowledge in addition to advantages, disadvantages, security and necessity perceptions. Each domain consists of Likert scale questions of 5 points. The questions were scored as the worst answer (1) and the best (5). A total of 109 questionnaires were filled by participants who spent at least 6 months in primary health care units. Then the health care workers were attended an orientation program and the questionnaire was re-filled once more. A total of 104 was recollected. Ethical issues were considered. Results: 50.5% of health care workers were aware of telehealth; 66.7% of health care workers with master’s degree were aware of telehealth in comparison to 31.8% among those with a diploma, 64.3% of physicians were aware of telehealth while 9.6% of nurses were aware. The score of knowledge and attitude increased from 130±23.538 to 156.49±18.456 after the educational program. Conclusion: Half of health care workers were aware of telehealth; the orientation improved the Healthcare Workers’ knowledge and attitude.

One of the core challenges to achieve Land Degradation Neutrality (LDN) is to spatially identify, and strategically prioritise, the areas to implement actions to avoid, reduce and reverse land degradation. To achieve this, a tool for a participatory and data-driven assessment considering both the biophysical, and socio-economic dimensions of land degradation across scales was developed for Ecuador. In this paper, we present the methodology and results obtained, including the spatially explicit interactive tool developed to integrate indicators that support the scaling-up of sustainable land management (SLM). The process involved specialists from various national and international institutions, as well as decision makers from the public sector and other relevant stakeholders. Cloud computing allowed the integration of five main sources of data: (1) the results of a participatory land degradation assessment based on an expert knowledge questionnaire following the Land Degradation Assessment in Drylands (LADA) and World Overview of Conservation Approaches and Technologies (WOCAT) methodology; (2) the Hand-in-Hand Initiative Ecuador typology maps based on poverty maps and estimated agricultural potential and efficiency scores using household surveys on agricultural production; (3) National data sets on land cover and land use, soil properties, and hydro climatic indicators; (4) global satellite-derived LDN indicators, such as Land Productivity Dynamics; and (5) Documented SLM practices from WOCAT Global SLM Database. The tool is based on a Google Earth Engine application and allows decision makers to easily compare results and obtain statistics at different spatial scales and landscapes, including 647 Land Use Systems delimited by experts. It also includes a multi-criteria module to identify areas with specific characteristics to prioritise different types of interventions to achieve the country´s LDN targets. Convergence of local and global evidence allowed the identification of hotspots of degradation as well as areas of false positives/negatives - if only global or remote sensing indicators were considered. The participatory process contributed to strengthening multi-sector cooperation mechanisms and to guaranteeing ownership of the tool and the results. The system will support Ecuador’s efforts to monitor and report progress towards LDN to the United Nations Convention to Combat Desertification. The system´s code is shared as a repository at Earth Engine and can be adapted to and used by other countries and regions.

Cardiac imaging is the cornerstone of defining the etiology, quantification and management of mitral regurgitation (MR). This continues to be even more so the case with emerging trans-catheter techniques to manage MR. Transthoracic echocardiography remains the first line imaging modality to assess MR but has limitations. Cardiac MRI(CMR) provides the advantages of quantitative non-visual estimation, 3D volumetric data, late gadolinium, T1 and extracellular volume measurements to comprehensively assess mitral valvular pathology, cardiac remodeling and the prognostic impact of therapies. This review describes the superiority, technical aspects and growing evidence behind CMR, and lays the roadmap for the future of CMR in MR.

Recent revisions to the definition of the “waters of the United States” (WOTUS) have considerably altered how wetlands are federally regulated under the Clean Water Act. The two most recent modifications to WOTUS, the Clean Water Rule (CWR) and the Navigable Waters Protection Rule (NWPR), represent two opposing approaches to the federal wetland policy. Despite their implementation, the impacts of these rules on the regulation of wetlands have as of yet been poorly characterized at broad spatial scales. Using New York State (NYS) as a case study, we evaluated the jurisdictional statuses of more than 373,000 wetlands under the CWR and the NWPR to assess the landscape-scale effects of WOTUS re-definitions. We found that statewide and within each of NYS’s hydrologic regions, the NWPR protects fewer wetlands and less total wetland area than the CWR. The efficacy of the two regulations varied considerably in space across NYS, highlighting the need for comprehensive, nationwide assessments of wetland policy outcomes. We also observed that both rules produced non-uniform patterns in jurisdiction across a range of landscape positions and wetland sizes, preferentially protecting large wetlands close to the stream network. This effect was particularly pronounced under the NWPR, which excludes all geographically isolated wetlands from protection. Our findings in NYS emphasize the existence of unique patterns in protected wetlands across spatial scales, highlighting the value in applying geospatial analyses to evaluate environmental policy.

COVID-19 Vaccines Tolerated in Patients with Paclitaxel and Docetaxel Allergy

Right superior vena cava draining in the left atrium is a rare anomaly, commonly associated with other cardiac defects. Herein we present the case of a 9 year old patient, asymptomatic but with right heart dilation with sinus venous defect, bilateral superior vena cavas with the right draining into the left atrium.

Objective: To study the value of fetal epicardial fat thickness (EFT) in gestational diabetes mellitus in the third trimester of pregnancy and its relationship with clinical parameters and perinatal outcomes. Methods: A total of 80 participants, including 40 with diagnosed GDM and 40 healthy pregnant women, were included in the study. Demographic data were obtained from medical records. Sonographic examinations were performed, such as amniotic fluid value, fetal biometric measurements, and Doppler parameters of the umbilical artery. Fetal EFT values were measured at the free wall of the right ventricle using a reference line with echocardiographic methods. Correlation tests were performed to evaluate the relationship between fetal EFT and clinical and perinatal parameters. P < 0.05 were interpreted as statistically significant. Results: The fetal EFT value was statistically higher in the GDM group than in the control group (p:0.000). Spearman correlation tests revealed statistically significant but weak positive correlations between fetal EFT value, 1-hour 100-gr OGTT, birth weight, and BMI (r: 0.198, p:0.047; r:0.395, p:0.012; r:0.360, p:0.042, respectively). The optimal fetal EFT threshold for predicting GDM disease was found as 1.55 mm, with a specificity of 74.4% and sensitivity of 75.0%. Statistically significant differences between the two groups in umbilical artery Doppler resistance index (RI), pulsatility index (PI), and systolic/diastolic ratio (S/D) were not found (p:0.337; p:0.503; p:0.155;). BMI and amniotic fluid volume were higher in the GDM group compared to the control group (p:0.009; p:0.000). Conclusion: This study demonstrated that increased fetal EFT may occur as a reflection of changes in glucose metabolism in intrauterine life. Future studies with larger series, including the study of neonatal metabolic parameters, will contribute to the understanding of the importance of fetal EFT in determining the metabolic status of the fetus.

Purpose: Cardiac resynchronization therapy (CRT) has a positive effect on the improvement of functional mitral regurgitation in patients with heart failure with reduced ejection fraction. However geometric changes in the mitral valve apparatus, subvalvular structures and their contribution to the improvement of mitral regurgitation after CRT have not been clearly defined. The aim of our study was to evaluate the geometric parameters of mitral valve apparatus measured with 3Dimensional (3D) transesophageal echocardiography (TEE) before CRT implantation and to determine the parameters predicting the improvement of mitral regurgitation after CRT. Methods: In this prospective study thirty patients with moderate or severe mitral regurgitation with low EF heart failure planned for CRT implantation and had an indication for TEE were included. Effective regurgitant orifice (ERO) and regurgitant volume (RV) measurements were performed before CRT implantation. Detailed quantitative measurements of mitral valve were done from recorded images by 3D TEE. ERO, RV measurements were repeated to evaluate mitral regurgitation at the end of 3rd month. Results: There were no significant changes in left ventricular EF and left ventricular diameters at third month follow-up, whereas ERO and RV values were decreased. posterior leaflet angle was found higher in non-responder group compared to responder group. (28,93 ± 8,41 vs 41,25 ± 10,90, p = 0,006). Conclusion: Heart failure patients with moderate or severe functional mitral regurgitation who underwent CRT implantation were found lower posterior leaflet angle which was measured by 3D TEE in the patient group whose mitral regurgitation improved after CRT.

Background:  Heterozygote carriers of potentially pathogenic variants in the cystic fibrosis transmembrane conductance regulator ( CFTR) gene have increased asthma risk. However, the frequency and impact of CFTR variation among individuals with asthma is unknown. Objective: To determine whether potentially pathogenic  CFTR variants associate with disease severity and whether individuals with two potentially pathogenic variants exist in a severe asthma-enriched cohort . Methods: We analyzed sequencing data spanning a 190.5Kb region of  CFTR in participants from the Severe Asthma Research Program (SARP1-3). Potentially pathogenic, rare  CFTR variants (frequency<0.05) were classified as CF-causing or of varying clinical consequences (VVCC) (CFTR2.org). Regression-based models tested for association between  CFTR genotypes (0-2 potentially pathogenic variants) and severity outcomes. Results: Of 1401 participants, 9.5% (134) had one potentially pathogenic variant, occurring more frequently in non-Hispanic white (NHW, 10.1% [84 of 831]) compared to African American individuals (AA, 5.2% [22 of 426]). We found ≥2 potentially pathogenic  CFTR variants in 1.4% (19); 0.5% (4) of NHW and 2.8% (12) of AA. Potentially pathogenic  CFTR variant genotypes (≥1 or ≥2 variants) were not cumulatively associated with lung function or exacerbations. In NHW, we found three F508del compound heterozygotes with F508del and a VVCC (two 5T;TG12[c.1210-11T>G] and one Arg1070Trp) and a homozygote for the VVCC, 5T;TG12. Conclusions: We found potentially pathogenic  CFTR variants within a severe asthma-enriched cohort , including three compound heterozygote genotypes variably associated with CF in NHW individuals. These findings provide the rationale for  CFTR sequencing and phenotyping of CF-related traits in individuals with severe asthma.

Background: Cardiac Sympathetic Denervation (CSD) involves surgical removal of lower half of the stellate ganglion and the T1-T4 ganglia for reducing sympathetic discharge to the heart. CSD is a useful therapeutic option in patients with ventricular tachycardia (VT) when they are non-responsive to standard drug therapy or catheter ablation. We report here the clinical profile and long-term outcome of all our patients who underwent CSD for refractory VT or VT storm. Method: Data of all patients who underwent CSD from 2010 to 2019 was analysed. They were regularly followed up, focusing on arrhythmia recurrence. Complete response to CSD was defined as more than 75% decrease in the frequency of VT. Results: A total of 65 patients (50 male, 15 female) underwent CSD in the above-mentioned period and the duration of follow-up was 27±24 months. The underlying substrate was for VT was coronary artery disease in 30 (46.2%) patients and 35 (53.8%) patients had a variety of other causes. Complete response to CSD was attained in 47 (72.3%) patients. There was a significant decline in the incidence of number shocks after CSD (24±37 vs 2±4; p <0.01). Freedom from a combined end point of ICD shock or death at the end of two years was 51.5%. Advanced NYHA class (III and IV) was the only parameter shown to have significant association with this combined end point. Conclusion: The current retrospective analysis reemphasize the role of surgical CSD in the treatment of patients with refractory VT or VT storm.

Violence in Rakhine, Myanmar forcibly displaced nearly one million Rohingya who took refuge in Cox’s Bazar–Teknaf peninsula of Bangladesh. Initially, nearly 2,000 ha of forested lands had to be cleared to accommodate them in an area, that is ecologically very sensitive. Fuelwood collection and illegal logging have become widespread since their arrival, causing severe environmental degradation, including loss of a vast amount of forest cover. To devise conservation strategies of a highly sensitive ecosystem, it is imperative to understand the degree of forest cover deterioration and associated impacts related to Rohingya emigration. This study employed satellite images to monitor and model spatiotemporal pattern of forest cover degradation, and loss of ecosystem function in the peninsula. Supervised classification method was used to derive multidate land use/cover data which was then utilized to monitor spatiotemporal pattern of forest cover change from 2017–2019. Dynamic modelling was performed to predict changes in the forest covers using markov cellular automata. Analysis revealed that 3,130 ha of different forested covers were transformed into either refugee camps or degraded forest cover between 2017 and 2019. Prediction showed that around 5,115 ha of forest may experience loss from 2019–2027. Furthermore, above ground biomass and carbon stock estimation indicated a consistent loss, which is likely to swell if present rate of deforestation continues. The findings of this work have considerable implications in developing conservation decisions, priority interventions and public policies to save an ecologically sensitive area.

Global change is altering patterns of community assembly, with net outcomes dependent on species’ responses to the environment, both directly and mediated through biotic interactions. Here, we assess alpine plant community responses in a 15-year factorial nitrogen addition, warming and snow manipulation experiment. We used a dynamic competition model to estimate the density-dependent and independent processes underlying changes in species-group abundances over time. Density-dependent shifts in competitive interactions drove long-term changes in abundance of species-groups under global change. Density-independent processes were important when counteracting environmental drivers limited the growth response of the dominant species. Furthermore, competitive interactions shifted with environmental change, primarily with nitrogen, and drove non-linear abundance responses across environmental gradients. Our results highlight that global change can either reshuffle species hierarchies or further favor already dominant species; predicting which outcome will occur requires incorporating both density-dependent and independent mechanisms and how they interact across multiple global change factors.

American Oil Chemists’ Society (AOCS)’s Official Method Cd 18-90 for p-Anisidine Value (pAV) is commonly used to evaluate secondary oxidation in fish oils. Flavoring agents in fish oil products may interfere with pAV and lead to inaccurate results. The Global Organization for EPA and DHA (GOED) recommends a protocol for calculating pAV of flavored fish oils, based on the assumption that flavors’ contribution to the pAV does not change over the course of oxidation. The objective of this study was to test this assumption. All fourteen flavors evaluated increased the pAV when added to fresh fish oil; chocolate-vanilla and lemon flavors generated the largest increase. Under accelerated oxidation conditions, both chocolate-vanilla and lemon flavors had a similar effect; oxidized flavored fish oils had lower pAV than oxidized fish oils with newly added flavors. This was due to either an antioxidant effect of the flavor or degradation of the flavor during oxidation. Following the GOED recommendation, we would have underestimated the oxidation in the flavored oils. For this reason, pAV of flavored fish oils should be considered with caution and used in combination with other secondary oxidation markers when possible.

The rise of sedimentary ancient DNA (sedaDNA) studies has opened up new possibilities for studying pre-historic ecology. The use of sediments to identify organisms even where macroscopic remains are limited or no longer exist is an exciting and potentially ground-breaking area of genomics. There are special considerations however when managing this substrate in Indigenous Australian contexts. Sediments and soils are often considered as waste by-products during archaeological and paleontological excavations, and as such are not typically considered of high value in ethical considerations in traditional western research. Nevertheless, the product of sedaDNA work – genetic information from past fauna, flora, microbial communities, and human ancestors – is likely to be of cultural value for Indigenous peoples. We argue that the integration of Traditional Knowledges into sedaDNA research would a) allow identification of sensitive, secret, or sacred genomic data, and b) improve research outcomes by providing ecological context for species through multi-millennia oral histories.

The commentary discusses the importance of developing Universal Health Coverage strategies through the lens of complex systems framework that evaluates policies not only in terms of the final desired outcome but also as an interplay of disparate views among diverse actors in the system. This view also confers a degree of agency and autonomy on the individual actors, whether they be patients or healthcare workers, and necessitates the inclusion of bottom-up participatory process in the development of UHC policies and interventions. These are consistent with the Primary Health Care principles articulated in the 1978 Alma Ata Declaration and will need to be integrated into the health system development framework to achieve UHC. Ultimately, this approach would encourage the creation of a more cooperative and adaptive policy environment in which each actor is encouraged to collaborate and are nudged toward a desirable outcome rather than through coercive means.

Urbanization is recognized as an important driver of the diversity and abundance of tree associated insect herbivores, but its consequences for insect herbivory are controversial. A likely source of variability among studies is the insufficient consideration of intra-urban variability in forest cover. With the help of citizen scientists, we investigated the independent and interactive effect of urbanization and local canopy cover on insect herbivory in the pedunculate oak (Quercus robur) throughout most of its geographic range in Europe. The damage caused by chewing insect herbivores as well as the incidence of leaf-mining and gall-inducing herbivores consistently decreased with increasing urbanization around focal oaks. Herbivory by chewing herbivores increased with increasing forest cover, regardless of urbanization. In contrast, an increase in local canopy cover buffered the negative effect of urbanization on leaf-miners and strengthened its effect on gall-inducers. These results show the complexity of plant-herbivore interactions in urbanized areas, highlighting that the presence of local canopy cover within cities has the potential to attenuate or modify the effect of urbanization on biotic interactions.

Comment on Platts-Mills T, Caraballo L, Jacquet A, Zarzuk J. Dust mite allergy. In: Dramburg S, Hilger C, Santos AF, de Las Vecillas L, Aalberse RC, Acevedo N, et al. EAACI Molecular Allergology User’s Guide 2.0. Pediatr Allergy Immunol. 2023 Mar;34 Suppl. 28:e13854.