nSARS-Cov-2, pulmonary edema and thrombosis: possible molecular insights using miRNA-gene circuits in regulatory networks

Background

Given the worldwide spread of the novel Severe Acute Respiratory Syndrome Coronavirus 2 (nSARS-CoV-2) infection pandemic situation, research to repurpose drugs, identify novel drug targets, vaccine candidates have created a new race to curb the disease. While the molecular signature of nSARS-CoV-2 is still under investigation, growing literature shows similarity among nSARS-CoV-2, pulmonary edema, and thromboembolic disorders due to common symptomatic features. A network medicine approach is used to to explore the molecular complexity of the disease and to uncover common molecular trajectories of edema and thrombosis with nSARS-CoV-2.

Results and conclusion

A comprehensive nSARS-CoV-2 responsive miRNA: Transcription Factor (TF): gene co-regulatory network was built using host-responsive miRNAs and it’s associated tripartite, Feed-Forward Loops (FFLs) regulatory circuits were identified. These regulatory circuits regulate signaling pathways like virus endocytosis, viral replication, inflammatory response, pulmonary vascularization, cell cycle control, virus spike protein stabilization, antigen presentation, etc. A unique miRNA-gene regulatory circuit containing a consortium of four hub FFL motifs is proposed to regulate the virus-endocytosis and antigen-presentation signaling pathways. These regulatory circuits also suggest potential correlations/similarity in the molecular mechanisms during nSARS-CoV-2 infection, pulmonary diseases and thromboembolic disorders and thus could pave way for repurposing of drugs. Some important miRNAs and genes have also been proposed as potential candidate markers. A detailed molecular snapshot of TGF signaling as the common pathway, that could play an important role in controlling common pathophysiologies among diseases, is also put forth.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s41544-020-00057-y.

Surgical cardiac sympathetic denervation in patients with VT storm: long term follow-up data

Background

Surgical Cardiac Sympathetic Denervation (CSD) is a procedure which involves surgical removal of terminal cervical and thoracic sympathetic ganglion for reducing sympathetic discharge to the heart. CSD is usually performed as a last desperate measure in treatment of ventricular tachycardia (VT). We report here the clinical profile and long-term follow-up of all our patients who underwent CSD (unilateral or bilateral) predominantly upfront prior to considering catheter ablation of VT for VT storm.

Material and methods

We retrospectively collected data of all patients who underwent CSD for VT storm between year 2010 till 2019. Success of CSD was defined as successful discharge of patient from the hospital after the procedure more than 75% decrease in the frequency of VT after two weeks of surgical procedure.

Results

A total of 65 patients underwent CSD in the above-mentioned period and the average duration of follow-up was 28 months. The clinical parameters, demographic data and outcome analysis is provided in details in table 1. Only 14 (21.5%) patients underwent attempt of catheter ablation of VT prior to considering CSD. CSD was successful in 53 (81.5%) of patients. There was a significant decline in the incidence of number of ICD or external shocks before and after CSD (25.2±39.4 vs 1.09±2.9) respectively. There was no significant effect of CSD on ejection fraction. None of the available clinical parameters predicted the success of CSD.

Discussion and conclusion

The current retrospective analysis reemphasize the role of surgical CSD in treatment of patients with VT storm. As in predominant patient's CSD was performed even before the attempting catheter-based ablation, it brings in a new dimension in the treatment of VT. Efficacy of CSD (81.5%) in experienced hand is equivalent or even better than catheter-based ablation in patients with VT storm.

Funding Acknowledgement

Type of funding source: None

CFD simulation of convective heat transfer in vessel with mechanical agitation for milk

Computational fluid dynamics (CFD) analysis using ANSYS Fluent software has been carried out to investigate velocity profiles and thermal characteristics of milk during heating under mechanically agitated condition. In earlier article experimental data on forced convection heat transfer coefficient h - and correlations of the form N u = a · R e b · P r 0.33 for cow milk, standardised milk and full cream milk in Baffled vessel and Unbaffled vessel with scraping, using Propeller, Flat Six Blade Turbine (FBT), Inclined Six Blade Turbine (IBT) and Paddle impellers were reported. It was noted milk in Baffled vessel with Paddle impeller provided highest h - even at lower rotational speeds followed by Propeller, FBT and IBT impellers. In Unbaffled vessel with scraping, Propeller provided the highest h - followed by FBT and IBT impellers. Hence, the present investigation has been carried out to validate and understand how different velocity of flow currents and their magnitude influence the heat transfer coefficient values in CFD simulation. It also justifies the relative performance of the impellers delineated in the earlier paper. In addition, theoretical values of heat transfer coefficients computed using CFD shows close agreement with experimental values.

Quinolone resistance among Salmonella Kentucky and Typhimurium isolates in Tunisia: first report of Salmonella Typhimurium ST34 in Africa and qnrB19 in Tunisia

AIMS

Characterization of quinolone-resistant Salmonella Kentucky and Typhimurium isolates in Tunisia from various sources, detection of some plasmid-mediated quinolone resistance genes and the genetic relatedness.

METHODS

A total of 1404 isolates of S. Kentucky (n = 1059)/S. Typhimurium (n = 345) from various sources from all over Tunisia were tested for quinolone resistance by disk diffusion method. Minimum inhibitory concentrations of nalidixic acid, ciprofloxacin and ofloxacin were determined. Quinolone-resistant isolates were screened for plasmid-mediated quinolone-resistance genes (qnrA,qnrB,qnrS, aac(6')-Ib-cr and qepA) by polymerase chain reaction (PCR). Mutations in the quinolone-resistance-determining regions of the gyrA and parC genes were detected by PCR and DNA sequencing. Pulsed-field gel electrophoresis and multilocus sequence typing were accomplished for isolates harbouring plasmid-mediated quinolone-resistance genes.

RESULTS

According to our selection criteria (NAL = resistance phenotype; CIP = resistant with diameter 0, or intermediate), only 63 S. Kentucky/41 S. Typhimurium isolates were investigated: 49% (5/104) were multidrug resistant. Two S. Typhimurium isolates harboured qnrB19 with different PFGE profiles. A mutation was detected in the gyrA gene for each of these two isolates. MLST revealed the presence of ST313 and ST34, an endemic sequence type.

CONCLUSION

Our study highlights the presence of quinolone multidrug-resistant Salmonella in humans and animals in Tunisia. This is the first report of S. Typhimurium ST34 in Africa and qnrB19 in Tunisia.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first report that describes not only the current epidemiological situation of the quinolone resistance in S. Kentucky and Typhimurium isolated from various sources and regions in Tunisia, but also, the genetic resistance determinants associated with phenotypic antibiotic resistance and the molecular mechanisms of their quinolone-resistance. Also, we provide the first report of S. Typhimurium ST34 in Africa, and the first report of qnrB19 in Salmonella in Tunisia.

Effect of group treatment on physical inactivity among Syrian refugees. Randomized controlled trial

Background

Refugees in Norway show low levels of physical activity, and have relatively high prevalence of pain disorders and post-traumatic symptoms. Physical inactivity can be both a cause of and a consequence of physical and mental symptoms. In CHART study (Changing Health and health care needs Along the Syrian Refugees' Trajectories to Norway), two group interventions, one based on physiotherapy and body awareness (PAAI) and the other on Teaching Recovery Techniques (TRT), were developed to treat patients with pain disorders and/or post-traumatic symptoms.

Objective

As a secondary outcome of study, we assessed the effect of these group interventions on physical inactivity.

Methods

We conducted a randomized controlled trial testing two group interventions. Syrian adults ≥16 years with pain and/or post-traumatic symptoms were randomized to either intervention group or control group. Effect of the intervention was measured after 8 (PAAI) and 6 (TRT) weeks, as relative risk (RR) with 95% confidence intervals for being inactive for intervention versus control groups, using log-binomial regression with adjustment for baseline inactivity and type of intervention (PAAI or TRT).

Results

177 Syrian refugees were recruited between July 2018-September 2019. 88 were randomized to the intervention group and 89 to the control group. Mean age was 35 years (SD 11) and 38% were women. Inactivity at recruitment was reported by 126 (71%) participants. The follow-up questionnaire was completed at 6/8 weeks by 116 (66%) participants. At that point, 39% in the intervention group were inactive as compared to 56% in the control group. RR for inactivity for the intervention group adjusted for inactivity at baseline was 0.68 (0.47-0.99) and remained 0.68 (0.48-0.99) when further adjusting for type of intervention (PAAI vs TRT).

Conclusions

PAAI and TRT group interventions reduced inactivity among refugees by 32%. Effect on physical inactivity was similar between PAAI and TRT interventions.

Key messages

Public health care should be aware of physical inactivity, especially in relation to pain disorders and post-traumatic symptoms among refugees. Group treatment interventions succeeded to encourage refugees to increase their physical activity.

Are Norwegian Municipality policies enabling intersectoral collaboration in migration health?

Issue

Sporadic accounts of initiatives, interventions and good practices in Migrant Health at the Municipality level account for Norways' lower score on “Measures to achieve change” in the Migrant Integration Policy Index (MIPEX). While the structure and organization at the municipality level should enable intersectoral action (as all under one umbrella), the municipal counties say lack of intersectoral collaboration is one of the main barriers for long-term public health work.

Description of the Problem

51 municipalities have an immigrant population larger than the national average 17,8% (2019). In a recent Country Assessment (part of Joint Action on Health Equity Europe), limited inter-sectoral action on the social determinants of health including migration was observed. Although multiple agencies are engaged in attempts to address these issues. While there is a drive to promote public health and primary health care in municipalities, these initiatives do not pay special attention to migrants. In the first stage of this project, we have reviewed municipal policy documents to map policy and measures on public health, migrant health and intersectoral collaboration. In the second stage, municipalities will be contacted to engage them in the implementation of intersectoral actions.

Results

The desk review and mapping show that only 8 of the “top” 32 municipalities mention “intersectoral” in the municipal master plan (5 were not available online), its mentioned in 9 action program/budgets, but not necessarily by the same municipalities. 15 of the municipalities mention migrants, but rarely in relation to health. We observe that, the size of the municipality, financial resources and support from the County are factors that may play a significant role in prioritising migrant health and intersectoral collaboration.

Lessons

Advocating for and supporting the local/municipal level for intersectoral action is highly relevant, timely and essential.

Key messages

Intersectoral action on the social determinants of migrants’ health needs to be implemented through municipal policies to reduce inequities in migrants’ health. Implementation on the local level is the main arena for good public health work and is crucial to ensure good health for migrants.

Stroke in Sierra Leonean Africans:Perspectives from a Private Health Facility

BACKGROUND

Several stroke studies in West Africans have demonstrated a high proportion of haemorrhagic stroke and poor outcomes. This may be due to the socioeconomic status of patients and inadequate clinical care. Outcomes may well be different if more informed patients treated in better facilities are studied.

OBJECTIVE

To study the pattern of stroke and stroke outcomes in African patients attending a private hospital in Sierra Leone METHODS: 150 consecutive African stroke patients admitted to a private hospital in Sierra Leone were studied. Demographic details, risk factors, clinical features including blood pressure were recorded. CT scans, ECG, serum cholesterol, and blood sugar were done. Patients were reviewed at day 30 and Rankin scores allocated. Two sample independent t-test was used to compare means, and chi square to compare variables.

RESULTS

Hypertension was the most common risk factor present in 77.6% of patients prior to admission with diabetes in 29.5%. Other risk factors include previous stroke (11.7%), smoking (6.3%), hypercholesterolemia (23.4%), high alcohol intake (28.8%) and lack of exercise according to self-evaluation (87.5%). 76.3% of patients had ischaemic and 18.2% haemorrhagic stroke. 41% of patients aged 50 years or less had haemorrhagic stroke and 9.3% of patients had atrial fibrillation. In-patient mortality was 10.6%.

CONCLUSION

Stroke types and outcomes are different from those generally reported from the sub-region. This may well be due to the population studied, and the level of care provided by a private facility. Socio-economic factors, literacy and clinical care are likely determinants of stroke types and outcomes in African patients. . More detailed studies to confirm the effects of socioeconomic factors on stroke pattern and outcomes in Africa are needed.

Can innovative digital collaborations help overcome barriers to intersectoral collaboration?

Issue

Health in all policies is desirable, but moving from the silos approach is a challenge for health care systems. New health policies require more cooperation and broader collaboration between governmental, private and volunteer sector, as well as across professions. Though it is key to implementation of national policies and long-term public health work at the local level, intersectoral collaboration remains elusive. Professionals working with public health and migrant health across Norway often work independently of each other and other sectors.

Description of the Problem

Evaluation of the Norwegian network for migrant friendly hospitals showed that with the opportunity to meet and share experiences, participants used the new knowledge and network in developing their practice and organisation of services. They experienced greater support to challenge status quo in their institutions. However, fear of making the network “too big to handle” is a barrier to creating intersectoral network. In a recent survey (2017), health personnel ask for digital solutions for finding resources and support in their practice to give better health care to immigrant patients.

Results

The newly (2020) knowledge HUB part of JAHEE actions brings stakeholders together at the local, regional and national level, ensuring access to the same knowledge, increase evidence based decisions among stakeholders when choosing interventions on the local, regional and national level, including sharing of good practices and promising initiatives at a national level so that they can be replicated.

Lessons

Professional networks that are coordinated and collaborative are important for development of services and implementation of measures for migrant health. However, expanding them across sectors and fields may create challenges. Combining sectoral networks with a common digital platform may overcome some of these challenges.

Key messages

Exploiting the potential of collaborative digital solutions may help overcome some barriers to intersectoral approach to migrant health. Coordinated collaborative professional networks can support the participants in developing their practice and organisation of services for migrants.

Access to healthcare and self-rated health among refugees in transit and after arrival in Norway

Background

Lack of basic infrastructure and poor provision of health services in conflict settings and during flight can have a negative impact on health. The overall health status of refugees seems to improve after arrival at a safe destination. This may be related to a safer environment and better access to health care services, but prior studies on this topic are limited. This study aims to assess self-perceived access to healthcare and its relationship with self-rated health (SRH) among refugees in transit and when settled in a host country.

Methods

We used data from the CHART study (Changing Health and health care needs Along the Syrian Refugees' Trajectories to Norway), which includes a cohort of 353 Syrian refugees who were contacted in 2017-2018 in Lebanon while waiting for relocation, and one year after their arrival to Norway. Information on self-perceived access to healthcare and its association with SRH was analyzed separately at each time-point. Data analysis was performed with STATA using logistic regression adjusting for age, gender, ethnicity and years of education and presented as adjusted odds ratios (AOR) with 95% CI.

Results

Fifteen percent reported good access to healthcare and 62% reported good SRH in Lebanon vs. 91% and 77% respectively, in Norway. Measures in Lebanon showed no association between access to healthcare and good SRH (AOR: 1.2 (0.6-2.2)), and men reported worse access to healthcare than women (AOR: 0.5 (0.3-1.0). In Norway, access to healthcare was strongly associated with good SRH (AOR: 4.7 (2.1-10.7) and was negatively associated with belonging to one specific minority group (AOR: 0.1 (0.0-0.3)).

Conclusions

Both SRH and perceived access to care improved from being in transit to being settled in Norway, the latter substantially more. There was a significant association between access to healthcare and good SRH after the refugees' arrival to a safe host country but not in transit.

Key messages

Refugee’s self-reported health and access to healthcare seem to improve shortly after arrival to a host country. To ensure that the UN’S Sustainable Development Goals concerning health equity are reached, refugees’ access to healthcare in transit and its impact on overall health needs to be addressed.

Violence prevention in vulnerable groups: the case of children and gender-based violence

As of January 2018, nearly 50 million children had been uprooted from their homes due to violence, poverty or natural disasters. In 2016, one in four people seeking asylum in the EU are children.

An analysis of nationally representative survey data on the prevalence of violence against children in 96 countries estimates that 1 billion children globally have experienced emotional, physical or sexual violence in the past year. The UN Convention on the Rights of the Child, ratified by nearly all states, must be fully implemented complied with. To support the implementation of the Convention, ten UN agencies incl. WHO have published the INSPIRE Handbook a technical package with seven strategies to end violence against children.

Another significant public health issue that needs to be addressed is sexual and gender-based violence (SGBV). Evidence shows that being an irregular migrant or asylum seeker appears to make an individual more vulnerable to SGBV, including sexual assault and rape by traffickers and smugglers. Working alongside displaced communities and with different partners across multiple sectors are the strategies to reduce the risks of SGBV and to ensure support for survivors.

Non-communicable diseases and use of medication among Syrian refugees: a prospective cohort study

Background

Conflict-driven disruption in continuity of care for non-communicable diseases (NCDs) is likely to have adverse public health impact. Yet, data on the prevalence and treatment coverage of NCDs among refugees is scarce. In this study we aim to assess the changes in prevalence of NCDs and use of relevant medication among Syrian refugees from a near-conflict phase in Lebanon to a resettlement phase in Norway.

Methods

This is a prospective cohort study. Survey data were collected during 2017-2018 among adult Syrian refugees in Lebanon selected for quota resettlement and at follow-up approximately one year after resettlement in Norway. Our primary outcomes were changes in NCDs as defined by the WHO and use of relevant medication. We calculated prevalence proportions with confidence intervals and assessed changes in prevalence over time using generalized estimating equations.

Results

Altogether 353 Syrians participated. The median age was 34 years and 51 percent were women. The overall prevalence of NCDs was 12 (9-16) percent at baseline and 9 (6-12) percent at follow-up. The odds ratio for reporting any NCD at follow-up compared to baseline was 0.68 (0.46, 1.00). Among those reporting NCDs, the prevalence of using either antithrombotic or cholesterol lowering medication, antihypertensives, antidiabetics, or drugs for asthma or chronic obstructive pulmonary disease was 55 (39-70) percent at baseline and 63 (44-80) percent at follow-up. The odds ratio for using relevant medication at follow-up compared to baseline was 1.01 (0.63, 2.05).

Conclusions

In our study around one tenth of the refugees reported at least one NCD. Nearly half of those reporting NCDs in a conflict-near setting did not seem to receive relevant medication, while the same was true for more than one third of respondents after resettlement. We call for innovative public health approaches and interventions to protect continuity of care for NCDs in settings of conflict-driven exodus.

Key messages

A high share of Syrian refugees reporting NCDs do not seem to receive relevant medication. The management of NCDs among refugees needs attention in order to avoid negative health effects.

Challenges and opportunities in promoting health equity for migrants

Issue

What has to be done to achieve health equity for migrants? International bodies have published many weighty declarations and recommendations to this end, but these need to be ordered and synthesised. A recurring theoretical problem is how to disentangle the health effects of socioeconomic position (SEP) and migrant status, in order to develop policies that effectively address both factors.

Description of the problem

As part of the Policy Framework for Analysis (PFA) for Work Package 7 of the Joint Action on Health Equity Europe (JAHEE), key policy documents between 2007 and 2018 were reviewed to form a ‘Road Map' from which a coherent synthesis was extracted. The PFA also developed a model for conceptualising the joint influence of SEP and migrant status. What is the relationship between these, and what policy approaches does it imply?

Results

The main recommendations of the ‘Road Map' were summarised in two categories: ‘upstream' measures (data collection and research, governance, and intersectoral action to tackle social determinants of health) and ‘downstream' ones (access to health services, responsiveness to migrants' needs, and attention for vulnerable groups). In the past, ‘upstream' measures have been unduly neglected. According to the proposed model, migrant status can have both direct effects on health and indirect ones that are mediated via SEP. Along the indirect pathways, migrants may suffer from increased exposure and/or increased vulnerability to health threats associated with low SEP.

Lessons

A high degree of consensus already exists about health inequities affecting migrants and the measures needed to tackle them. The urgent challenge at the moment is to put these conclusions into practice. To this end, there is little point in tackling socioeconomic inequities and those linked to migration and ethnicity as though they had nothing to do with each other.

Key messages

The recommendations of international bodies on migrant health from 2007-2018 can be summarized in three ‘upstream’ measures and three ‘downstream’ ones. Promoting health equity for migrants requires breaking down the silos in which work on migration and on SEP has hitherto been carried out.

Changes in health among Syrian refugees along their migration trajectories from Lebanon to Norway: a prospective cohort study

OBJECTIVES

Conflict-driven displacement is an indisputable social determinant of health. Yet, data on changes in health along the migration trajectories of refugees are scarce. This study aims to assess the longitudinal changes in somatic and mental health and use of medication among Syrian refugees relocating from a conflict-near transit setting in the Middle East to a resettlement setting in Europe. Further, we examine different health status trajectories and factors that predict health in the early postmigration period.

STUDY DESIGN

This is a prospective cohort study.

METHODS

Survey data were collected during 2017-2018 among adult Syrian refugees in Lebanon selected for quota resettlement and at follow-up approximately one year after resettlement in Norway. Our primary outcomes were non-communicable disease (NCD), chronic impairment, chronic pain, anxiety/depression, post-traumatic stress symptoms, and daily use of drugs. We estimated longitudinal changes in prevalence proportions using generalized estimating equations and evaluated effect modification of health outcomes.

RESULTS

Altogether, 353 Syrians participated. NCDs declined (12%-9%), while the prevalence of chronic impairment, chronic pain, and use of drugs remained nearly unchanged (29%-28%, 30%-28%, and 20%-18%) between baseline and follow-up. Conversely, mental health outcomes improved (anxiety/depression 33%-11%, post-traumatic stress disorder 5%-2%). Effect modifiers for improvement over time included younger age, short length of stay, and non-legal status in the transit country before resettlement in Europe.

CONCLUSIONS

We find that mental health outcomes improve from a conflict-near transit setting in Lebanon to an early resettlement setting in Norway, while somatic health outcomes remain stable. Temporal changes in health among moving populations warrant attention, and long-term changes need further scrutiny.

Community-based active case-finding to reach the most vulnerable: tuberculosis in tribal areas of India

<sec> <title>BACKGROUND</title> India has the world's largest indigenous/tribal population. Many areas with large tribal populations suffer from weak infrastructure and services. Surveys have shown a high prevalence of TB among Saharia communities, who rarely access public services. We evaluated a community-based active TB case-finding intervention. </sec> <sec> <title>METHODS</title> Community health workers screened people for TB symptoms in Saharia communities, made referrals, collected sputum for transport to laboratories, and initiated and supported anti-tuberculosis treatment. Microscopy testing was performed at government laboratories. The intervention tracked the people screened, referrals, the people tested, laboratory results, treatment initiation and outcomes. </sec> <sec> <title>RESULTS</title> Community health workers verbally screened 65 230 people, 8723 (13%) of whom had symptoms. Of these, 5600 were tested, 964 (17%) of whom were smear-positive. During the intervention, we observed a +52% increase in people tested at laboratories and an +84% increase in TB case notifications. Pre-treatment loss to follow-up decreased and treatment success increased slightly. </sec> <sec> <title>CONCLUSIONS</title> In India, particularly among tribal populations, many people with TB are missed by current approaches due to poor access. Community-based active case-finding can help identify more people with TB in tribal and remote rural areas by addressing barriers to health seeking as well as help reach ambitious country and global notification targets. </sec>.

Treatment and management strategies of onychomycosis

Onychomycosis is one of the most prevalent and severe nail fungal infections, which is affecting a wide population across the globe. It leads to variations like nail thickening, disintegration and hardening. Oral and topical drug delivery systems are the most desirable in treating onychomycosis, but the efficacy of the results is low, resulting in a relapse rate of 25-30%. Due to systemic toxicity and various other disadvantages associated with oral therapy like gastrointestinal, hepatotoxicity, topical therapy is commonly used. Topical therapy improves patient compliance and reduces the cost of treatment. However, due to poor penetration of topical therapy across the nail plate, research is focused on different chemical, mechanical and physical methods to improve drug delivery. Penetration enhancers like Thioglycolic acid, Hydroxypropyl-β-cyclodextrin (HP-β-CD), Sodium lauryl sulfate (SLS), carbocysteine, N-acetylcysteine etc. have shown results enhancing the drug penetration across the nail plate. Results with physical techniques such as iontophoresis, laser and Photodynamic therapy are quite promising, but the long-term suitability of these devices is in need to be determined. In this article, a brief analysis of the treatment procedures, factors affecting drug permeation across nail plate, chemical, mechanical and physical devices used to increase the drug delivery through nails for the onychomycosis management has been achieved.