Thromboembolic Events in Critically Ill Children with Multiple Risk Factors for Venous Thrombosis

The risk for venous thromboembolism (VTE) is considered to be low in the general paediatric intensive care unit (PICU) population, and pharmacological thromboprophylaxis is not routinely used. PICU patients considered at high-risk of VTE could possibly benefit from pharmacological thromboprophylaxis, but the incidence of VTE in this group of patients is unclear. This was an observational, prospective study at a tertiary multi-disciplinary paediatric hospital. We used comprehensive ultrasonography screening for VTE in critically ill children with multiple risk factors for VTE. Patients admitted to PICU ≥72 hours and with ≥two risk factors for VTE were included. Patients receiving pharmacological thromboprophylaxis during their entire PICU stay were excluded. Since pharmacological thromboprophylaxis has not been proven effective for central venous catheter(CVC)-related VTE, the primary outcome was VTEs not related to the use of a CVC. Ultrasonography screening of the great veins was performed at PICU discharge. Seventy patients with median (interquartile range) 3 (2-4) risk factors for VTE were evaluated. Median age was 0.34 years (0.03-4.3) and median PICU length of stay 9 days (5-17). Regarding the primary outcome, no symptomatic VTEs occurred and no asymptomatic VTEs were found on ultrasonography screening. The observed proportion of VTE, 0 in 70 patients, corresponds to a VTE incidence of 0-5.1%. Conclusion: No VTEs where pharmacological thromboprophylaxis could potentially have been an effective prophylactic measure were found. This indicates that VTE is an uncommon event even in a selected group of severely ill small children considered to be at high risk of VTE.

Rapid Serological Testing for Managing the COVID-19 Pandemic: A Review

With the onset of the novel coronavirus disease pandemic (COVID-19) that emerged from Wuhan in China, the need of the hour can be summarized into two groups. The first one is a potent vaccine as a prophylactic measure to prevent the virus from infecting people, and the second is a rapid diagnosis of the disease to help healthcare professionals and government authorities to plan and control the spread and provide effective care and treatment. This review delves into the latter, describing the COVID-19 and its treatment, including the race for an effective vaccine, and highlighting the role of serological testing in managing the pandemic since a well-designed study to understand mechanisms and serological correlations of protective immunity is crucial for rational clinical and public health policies. In conclusion, swift vaccination and response tactics, such as social distancing, hand hygiene, wearing of masks, and, if required, lockdown practices continue to be important in managing the pandemic while carefully monitoring any possible outbreak due to the variants.

Montmorillonite-Nasal-Gel, A Prophylactic Measure Against Covid-19

Since December 2019, a novel pneumonia caused by a novel coronavirus (SARS-CoV-2) has spread through the whole world. There are various ways to control the outbreak, such as vaccines, neutralizing antibodies, but prophylactic measures is still one of the important measures to control the outbreak like face masks. Montmorillonite-Nasal-Gel (MNG), a nasal spray gel consisting of a combination of 10% montmorillonite, 2% xylitol and water, has shown the effect to reduce viral infection. We tested the effect of MNG on SARS-CoV-2 infection by using a SARS-CoV-2 S protein pseudovirus system. To evaluate the efficacy of MNG against SARS-CoV-2 infection, SARS-CoV-2 were treated with 50% MNG in BSL-3 laboratory. These experiments appeared that MNG treatment greatly reduced the infection of SARS-CoV-2. As a nasal spray, it should not stimulate the airways. So we did a respiratory stimulating test and found that it has no stimulating effect on the respiratory tract. Montmorillonite is generally considered to have a amount of negative charge on the surface, it can absorb some viruses and bacteria. We assume that montmorillonite can physically adsorb SARS-CoV-2 too. As a personal protective equipment, MNG was approved by National Medical Products Administration (NMPA). MNG can further be used in the protection of all groups.

Potential Role of Vitamins A, B, C, D and E in TB Treatment and Prevention: A Narrative Review

(1) Background: Tuberculosis (TB) is one of the world’s top infectious killers, in fact every year 10 million people fall ill with TB and 1.5 million people die from TB. Vitamins have an important role in vital functions, due to their anti-oxidant, pro-oxidant, anti-inflammatory effects and to metabolic functions. The aim of this review is to discuss and summarize the evidence and still open questions regarding vitamin supplementation as a prophylactic measure in those who are at high risk of Mycobacterium tuberculosis (MTB) infection and active TB; (2) Methods: We conducted a search on PubMed, Scopus, Google Scholar, EMBASE, Cochrane Library and WHO websites starting from March 1950 to September 2021, in order to identify articles discussing the role of Vitamins A, B, C, D and E and Tuberculosis; (3) Results: Supplementation with multiple micronutrients (including zinc) rather than vitamin A alone may be more beneficial in TB. The WHO recommend Pyridoxine (vitamin B6) when high-dose isoniazid is administered. High concentrations of vitamin C sterilize drug-susceptible, MDR and extensively drug-resistant MTB cultures and prevent the emergence of drug persisters; Vitamin D suppresses the replication of mycobacterium in vitro while VE showed a promising role in TB management as a result of its connection with oxidative balance; (4) Conclusions: Our review suggests and encourages the use of vitamins in TB patients. In fact, their use may improve outcomes by helping both nutritionally and by interacting directly and/or indirectly with MTB. Several and more comprehensive trials are needed to reinforce these suggestions.

Insights into COVID-19 Vaccine Development Based on Immunogenic Structural Proteins of SARS-CoV-2, Host Immune Responses, and Herd Immunity

The first quarter of the 21st century has remarkably been characterized by a multitude of challenges confronting human society as a whole in terms of several outbreaks of infectious viral diseases, such as the 2003 severe acute respiratory syndrome (SARS), China; the 2009 influenza H1N1, Mexico; the 2012 Middle East respiratory syndrome (MERS), Saudi Arabia; and the ongoing coronavirus disease 19 (COVID-19), China. COVID-19, caused by SARS-CoV-2, reportedly broke out in December 2019, Wuhan, the capital of China’s Hubei province, and continues unabated, leading to considerable devastation and death worldwide. The most common target organ of SARS-CoV-2 is the lungs, especially the bronchial and alveolar epithelial cells, culminating in acute respiratory distress syndrome (ARDS) in severe patients. Nevertheless, other tissues and organs are also known to be critically affected following infection, thereby complicating the overall aetiology and prognosis. Excluding H1N1, the SARS-CoV (also referred as SARS-CoV-1), MERS, and SARS-CoV-2 are collectively referred to as coronaviruses, and taxonomically placed under the realm Riboviria, order Nidovirales, suborder Cornidovirineae, family Coronaviridae, subfamily Orthocoronavirinae, genus Betacoronavirus, and subgenus Sarbecovirus. As of 23 September 2021, the ongoing SARS-CoV-2 pandemic has globally resulted in around 229 million and 4.7 million reported infections and deaths, respectively, apart from causing huge psychosomatic debilitation, academic loss, and deep economic recession. Such an unprecedented pandemic has compelled researchers, especially epidemiologists and immunologists, to search for SARS-CoV-2-associated potential immunogenic molecules to develop a vaccine as an immediate prophylactic measure. Amongst multiple structural and non-structural proteins, the homotrimeric spike (S) glycoprotein has been empirically found as the most suitable candidate for vaccine development owing to its immense immunogenic potential, which makes it capable of eliciting both humoral and cell-mediated immune responses. As a consequence, it has become possible to design appropriate, safe, and effective vaccines, apart from related therapeutic agents, to reduce both morbidity and mortality. As of 23 September 2021, four vaccines, namely, Comirnaty, COVID-19 vaccine Janssen, Spikevax, and Vaxzevria, have received the European Medicines Agency’s (EMA) approval, and around thirty are under the phase three clinical trial with emergency authorization by the vaccine-developing country-specific National Regulatory Authority (NRA). In addition, 100–150 vaccines are under various phases of pre-clinical and clinical trials. The mainstay of global vaccination is to introduce herd immunity, which would protect the majority of the population, including immunocompromised individuals, from infection and disease. Here, we primarily discuss category-wise vaccine development, their respective advantages and disadvantages, associated efficiency and potential safety aspects, antigenicity of SARS-CoV-2 structural proteins and immune responses to them along with the emergence of SARS-CoV-2 VOC, and the urgent need of achieving herd immunity to contain the pandemic.

Septoplasty with and without additional sinonasal surgery: postoperative sequelae and the use of prophylactic antibiotics

Purpose One of the most common complications after septoplasty is a postoperative infection. We investigated the number of postoperative infections and unplanned postoperative visits (UPV) in septoplasties with and without additional nasal surgery at our institution and evaluated the role of antibiotic prophylaxis. Methods We collected data of all consecutive 302 septoplasty or septocolumelloplasty patients operated during the year 2018 at the Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital (Helsinki, Finland). Hospital charts were reviewed to record sociodemographic patient characteristics and clinical parameters regarding surgery and follow-up. Results Altogether 239 patients (79.1%) received pre- and/or postoperative prophylactic antibiotics and within this group 3.3% developed a postoperative infection. The infection rate in the non-prophylaxis group of 63 patients was 12.7% (p = 0.007). When all patients who received postoperative antibiotics were excluded, we found that the infection rate in the preoperative prophylaxis group was 3.8%, as opposed to an infection rate of 12.7% in the non-prophylaxis group (p = 0.013). When evaluating septoplasty with additional sinonasal surgery (n = 115) the rate of postoperative infection was 3.3% in the prophylaxis group and 16.7% in the non-prophylaxis group (p = 0.034). These results show a statistically significant stand-alone effect of preoperative prophylactic antibiotics in preventing postoperative infection in septoplasty, especially regarding additional sinonasal surgery. Conclusion The use of preoperative antibiotics as a prophylactic measure diminished statistically significantly the rate of infections and UPVs in septoplasty when all postoperative infections, superficial and mild ones included, were taken into account.

Le masque en temps de la Covid-19 : ce qu’il donne à penser

In this time of the Covid-19 pandemic, one experiences the other and self as mask wearers. Mask, which until now was mainly a reality of the medical world, has become an object of daily life. For some, it is indispensable and beneficial, and it has also become, for others, the symbol of freedom restriction by those in power. This article raises the debate above these different positions to apprehend what the mask makes one think. This study understands the mask from its roots in medical usage as a prophylactic measure. From semantical ethics of the term “mask,” the author shows that one’s responsibility is put at the first value on each mask covering halfway one’s face. This commitment serves as a basis for responsibility and tends towards hope. It is a responsibility extended to the environment since the mask, which is supposed to protect one from disease, turns into the trash, endangering the environment.

Laboratory-Generated DNA Can Cause Anomalous Pathogen Diagnostic Test Results

To meet the challenges imposed by the COVID-19 pandemic, research laboratories shifted their focus and clinical diagnostic laboratories developed and utilized new assays. Nucleic acid-based testing became widespread and, for the first time, was used as a prophylactic measure.