Level of Acceptance of COVID-19 Vaccine and Its Determinants among High Risk Groups for Severe COVID-19 Infection Living in Mogadishu Somalia

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which is widely referred to as “COVID-19”, has been infecting more than 5.5 million over 144 countries. A vaccine is considered to be the most awaiting intervention and hundreds of global R&D institutions engaged in unprecedented speed to develop the vaccine. The availability of COVID-19 vaccines may not translate into its uptake. Although governments will provide the vaccines, their uptake is voluntary. Objective: This study was carried out to evaluate the level of acceptance of COVID-19 vaccine and it’s determinants among high risk groups for severe COVID-19 infection living in Mogadishu Somalia. Methods: The study was cross-sectional, descriptive analysis conducted to obtain reliable information about the acceptance of COVID-19 vaccine and it is determinants among high-risk groups living in Mogadishu, Somalia. The calculated sample size was 404 using Cochran’s formula = Z2p(1 − p)/d2 and addition of 5% non-respondent rate. According to PESS population estimate in 2020, there are 17 districts. We grouped them into 2 strata and through simple random sampling one district was selected from each strata. After randomly selecting the two districts, three sub districts were randomly selected from each and then every second house (1, 3, 5) in the main roads will be selected. If target population were not found in the second selected house, the next house will be taken until sample size is obtained. Results: 59.4% of respondents were willing to accept and take vaccination while 40.6% of them were not accepting the vaccination. Being afraid of the side effect was the most common reason for not accepting the vaccine Conclusion: More than one third of respondents (40.6%) were not willing to accept the vaccination, knowledge towards COVID-19 was strongly associated with acceptance level of COVID-19 vaccine. Recommendation: Multi-sector organized awareness campaigns involving FMH as well as local authorities and civil society to enhance level of knowledge of community towards COVID-19.

COVID-19 associated liver injury:An updated review on the mechanisms and management of risk groups

Coronavirus disease 2019(COVID-19)has been associated with various liver injury cases worldwide.To date,the prevalence,mechanism,clinical manifestations,diagnosis,and outcomes of COVID-19-induced liver injury in various at-risk groups are not well defined.Liver injury may arise in the prevention and treatment of COVID-19 from direct causes such as viral infection and indirect causes such as systemic inflammation,hypoxic changes,and drugs that exacerbate any pre-existing liver disease.Studies have found that patients with underlying liver disease are at higher risk of COVID-19-induced liver injury.Certain condition of cardiopulmonary and metabolic diseases and vulnerable stages in lifespan may also involve in the development of COVID-19-induced liver injury.This review summarized studies of COVID-19-induced liver injury in different at-risk groups regarding their clinical characteristics,parameters,and correlations of the severity with these indicators and signs as well as potential treatment suggestions,to increase attention to physiological and pathological conditions and continue liver function monitoring as they can help in strengthening early supportive treatment and reducing the incidence of adverse outcomes.

A Simulation Model for the Risk of Fetal Exposure Originated by the Zika Virus (VIZK)

It is set and analyzed a simulation model based on non-linear ordinary differential equations to interpret the dynamics of the microcephaly incidence caused by the Zika virus in a risk group of pregnant women. This one is induced by a population of men in a reproductive age. Also, some parameters of the model were estimated for an average temperature of 23℃ and by using the adjusted functions from references [1] [2]. All system simulations were done with the Maple software and parameters values obtained from several sources (estimated, hypothetic, and form literature). It has been found that the application of contraceptive measures impacts the population of sexually active women. As result, the exposure to congenital abnormalities increases, particularly, microcephaly.

Exosomal glypican-1 is elevated in pancreatic cancer precursors and can signal genetic predisposition in the absence of endoscopic ultrasound abnormalities

BACKGROUND Individuals within specific risk groups for pancreatic ductal adenocarcinoma(PDAC)[mucinous cystic lesions(MCLs),hereditary risk(HR),and new-late onset diabetes mellitus(NLOD)]represent an opportunity for early cancer detection.Endoscopic ultrasound(EUS)is a premium image modality for PDAC screening and precursor lesion characterization.While no specific biomarker is currently clinically available for this purpose,glypican-1(GPC1)is overexpressed in the circulating exosomes(crExos)of patients with PDAC compared with healthy subjects or those harboring benign pancreatic diseases.AIM To evaluate the capacity of GPC1+crExos to identify individuals at higher risk within these specific groups,all characterized by EUS.METHODS This cross-sectional study with a prospective unicentric cohort included 88 subjects:40 patients with MCL,20 individuals with HR,and 20 patients with NLOD.A control group(CG)was submitted to EUS for other reasons than pancreatic pathology,with normal pancreas and absence of hereditary risk factors(n=8).The inclusion period was between October 2016 and January 2019,and the study was approved by the Ethics Committee of Centro Hospitalar Universitário de São João,Porto,Portugal.All patients provided written informed consent.EUS and blood tests for quantification of GPC1+crExos by flow cytometry and carbohydrate antigen 19-9(CA 19-9)levels by ELISA were performed in all subjects.EUS-guided tissue acquisition was done whenever necessary.For statistical analysis,SPSS®27.0(IBM Corp.,Armonk,NY,United States)version was used.All graphs were created using GraphPad Prism 7.00(GraphPad Software,San Diego,CA,United States).RESULTS Half of MCLs harbored worrisome features(WF)or high-risk stigmata(HRS).Pancreatic abnormalities were detected by EUS in 10.0%and 35.0%in HR and NLOD individuals,respectively,all considered non-malignant and“harmless.”Median levels of GPC1+crExos were statistically different:MCL[99.4%,interquartile range(IQR):94.9%-99.8%],HR(82.0%,IQR:28.9%-98.2%),NLOD(12.6%,IQR:5.2%-63.4%),and CG(16.2%,IQR:6.6%-20.1%)(P<0.0001).Median levels of CA 19-9 were within the normal range in all groups(standard clinical cut-off of 37 U/mL).Within HR,individuals with a positive history of cancer had higher median levels of GPC1+crExos(97.9%;IQR:61.7%-99.5%),compared to those without(59.7%;IQR:26.3%-96.4%),despite no statistical significance(P=0.21).Pancreatic cysts with WF/HRS were statistically associated with higher median levels of GPC1+crExos(99.6%;IQR:97.6%-99.8%)compared to those without(96.5%;IQR:81.3%-99.5%)(P=0.011),presenting an area under the receiver operating characteristic curve value of 0.723(sensitivity 75.0%and specificity 67.7%,using a cutoff of 98.5%;P=0.012).CONCLUSION GPC1+crExos may act as biomarker to support the diagnosis and stratification of PDAC precursor lesions,and in signaling individuals with genetic predisposition in the absence of EUS abnormalities.

Nursing Diagnostics of Nutrition Domain of NANDA International in Hemodialysis Patients

Introduction: The dialysis causes the loss of the nutrients and the elevation of catabolism, thus, patients in dialysis have at high risk for the loss of body reserves of protein and energy. Objective: To identify nursing diagnoses of nutrition domain of NANDA International in hemodialysis patients and to correlate them to the socioeconomic and clinical data. Design: Cross-sectional study. Setting: Performed in a large university hospital in northeastern Brazil. Participants: The first stage was carried out with 50 patients, selected with the following inclusion criteria: Being hospitalized and undergoing hemodialysis in that hospital;aged 18 years old or over;being conscious and oriented. Exclusion criteria were patients undergoing hemodialysis in that hospital with external service, pregnant women and patients being treated by plasmapheresis. In the second stage, participants were three nursing specialists in nephrology and nursing diagnoses. Methods: The defining characteristics of the nursing diagnoses inserted in the nutrition domain were observed in patients and then these data were judged by nurses, in order to identify diagnoses present in each patient. The Chi-square, Fisher’s exact and Mann-Whitney tests were used in the analysis of the relationship of socioeconomic and clinical data, with an adopted p value of p = 0.001), origin (p = 0.014), religion (p = 0.046) and income (p = 0.039), respectively. Conclusion: The variables that showed significant association were risk of impaired liver function and gender;imbalanced nutrition: More than body requirements and origin requirements;risk for deficient fluid volume and religion;and deficient fluid volume and income.

Mental disorders and sociodemographic variables in pop-ulation assisted by the Family Health Program in Brazil

Objectives: This paper aims to estimate the associations between common mental disorders (CMD) as well as cases of alcohol abuse/dependence (ADD) with sociodemographic variables in population assisted by Family Health Program (FHP) in Santa Cruz do Sul, Southern Brazil. Methods: All residents over 14 years of age from 3 areas assisted by the FHP were invited to participate between 10 February 2006 to 10 February 2007. Results: Of 2921 participants, the prevalence estimates of suspected cases of CMD and ADD were 29.93% and 12.07%, respectively. Female, unfavorable employment situation, low schooling and low income showed a positive and independent association with CMD. Male, unfavorable employment situation and CMD showed an independent association with ADD. Conclusions: Groups with unfavorable socioeconomic conditions present the highest risk and should be taken into account when planning public mental health policies.

New SRLG-diverse path selection algorithm in survivable GMPLS networks

In conventional shared risk link group （SRLG）-diverse path selection （CSPS） algorithm in survivable GMPLS networks, SRLG is taken into account when selecting the backup paths, while the primary path selection method is the sarne as the algorithms without SRLG constraint. A problem of CSPS algorithm is that, after a primary path is selected, the success probability to select an SRLG-diverse backup path for it is low. If SRLG is taken into account when computing the primary path, then the probability to successfully select an SRLG-diverse backup path will be much increased. Based on this idea, an active SRLG-diverse path selection （ASPS） algorithm is proposed. To actively avoid selecting those SRLG links, when computing the primary path, a link that share risk with more links is assigned a larger link cost. To improve the resource utilization ratio, it is permitted that the bandwidth resources are shared among backup paths. What is more, differentiated reliability （DiR） requirements of different customers are considered in ASPS algorithm. The simulation results show that, compared with CSPS algorithm, ASPS algorithm not only increases successful protection probability but also improves resource utilization ratio.

Prognostic Biomarkers for Hepatocellular Carcinoma Based on Serine and Glycine Metabolism-related Genes

Background and Aims:Targeted therapy and immunotherapy have emerged as treatment options for hepatocellular carcinoma(HCC)in recent years.The significance of serine and glycine metabolism in various cancers is widely acknowledged.This study aims to investigate their correlation with the prognosis and tumor immune microenvironment(TIME)of HCC.Methods:Based on the public database,different subtypes were identified by cluster analysis,and the prognostic model was constructed through regression analysis.The gene expression omnibus(GEO)data set was used as the validation set to verify the performance of the model.The survival curve evaluated prognostic ability.CIBERSORT was used to evaluate the level of immune cell infiltration,and maftools analyzed the mutations.DsigDB screened small molecule compounds related to prognostic genes.Results:HCC was found to have two distinct subtypes.Subsequently,we constructed a risk score prognostic model through regression analysis based on serine and glycine metabolismrelated genes(SGMGs).A nomogram was constructed based on risk scores and other clinical factors.HCC patients with a higher risk score showed a poor prognosis,and there were significant differences in immune cell infiltration between the high-and low-risk groups.In addition,three potential drugs associated with prognostic genes,streptozocin,norfloxacin,and hydrocotarnine,were identified.Conclusions:This study investigated the expression patterns of SGMGs and their relationship with tumor characteristics,resulting in the development of a novel model for predicting the prognosis of HCC patients.The study provides a reference for clinical prognosis prediction and treatment of HCC patients.

COVID-19 case fatality risk by age and gender in a high testing setting in Latin America: Chile, March-August 2020

Background:Early severity estimates of coronavirus disease 2019(COVID-19)are critically needed to assess the potential impact of the on going pandemic in differe nt demographic groups.Here we estimate the real-time delayadjusted case fatality rate across nine age groups by gender in Chile,the country with the highest testing rate for COVID-19 in Latin America.Methods:We used a publicly available real-time daily series of age-stratified COVID-19 cases and deaths reported by the Ministry of Health in Chile from the beginning of the epidemic in March through August 31,2020.We used a robust likelihood function and a delay distribution to estimate real-time delay-adjusted case-fatality risk and estimate model parameters using a Monte Carlo Markov Chain in a Bayesian framework.

Tumor microenvironment-based signatures distinguish intratumoral heterogeneity, prognosis, and immunogenomic features of clear cell renal cell carcinoma

Background:The tumor microenvironment(TME)performs a crucial function in the tumorigenesis and response to immunotherapies of clear cell renal cell carcinoma(ccRCC).However,a lack of recognized pre-clinical TME-based risk models poses a great challenge to investigating the risk factors correlated with prognosis and treatment responses for patients with ccRCC.Methods:Stromal and immune contexture were assessed to calculate the TMErisk score of a large sample of patients with ccRCC from public and real-world cohorts using machine-learning algorithms.Next,analyses for prognostic efficacy,correlations with clinicopathological features,functional enrichment,immune cell distribu-tions,DNA variations,immune response,and heterogeneity were performed and validated.Results:Clinical hub genes,including INAFM2,SRPX,DPYSL3,VSIG4,APLNR,FHL5,A2M,SLFN11,ADAMTS4,IFITM1,NOD2,CCR4,HLA-DQB2,and PLAUR,were identified and incorporated to develop the TMErisk signature.Patients in the TME high risk group(category)exhibited a considerably grim prognosis,and the TMErisk model was shown to independently function as a risk indicator for the overall survival(OS)of ccRCC patients.Expression levels of immune checkpoint genes were substantially increased in TME high risk group,while those of the human leukocyte antigen(HLA)family genes were prominently decreased.In addition,tumors in the TME high group showed significantly high infiltration levels of tumor-infiltrated lymphocytes,including M2 macrophages,CD8+T cells,B cells,and CD4+T cells.In heterogeneity analysis,more frequent somatic mutations,including pro-tumorigenic BAP1 and PBRM1,were observed in the TME high group.Importantly,19.3%of patients receiving immunotherapies in the TME high group achieved complete or partial response compared with those with immune tolerance in the TME low group,suggesting that TMErisk prominently differentiates prognosis and responses to immunotherapy for patients with ccRCC.Conclusions:We first established the TMErisk score of ccRCC using machine-learning algorithms based on a large-scale population.The TMErisk score can be utilized as an innovative independent prognosis predictive marker with high sensitivity and accuracy.Our discovery also predicted the efficacy of immunotherapy in ccRCC patients,indicating the intimate link between tumor immune microenvironment and intratumoral heterogeneity.

Surgical management in pediatric neuroblastoma diagnosis and treatment:a 20-year,single-center experience

Background The currently utilized International Neuroblastoma Risk Group(INRG)staging system developed in 2009 uses image-defined risk factors as a measure of surgical risk,separating resectable neuroblastoma from those best preceded by chemotherapy.The previous International Neuroblastoma Staging System was based primarily on surgical findings.We hypothesized there would be a change to the role of the surgeon in neuroblastoma treatment in the more recent decade.Methods This is a single center 20-year retrospective analysis of 104 patients with International Classification of Diseases-9 and-10 codes for neuroblastoma.Patient demographics,tumor site,cancer treatment modality,survival,biopsy technique,surgical intervention,and pathology staging were collected.Data was analyzed by analysis of variance(ANOVA)and Student’s t test.Results There was a decrease in open surgeries for extra-adrenal neuroblastomas in the later decade(77%,31%,P=0.01).There was a narrowing of the time interval to surgery in the later cohort,likely as a result of uniformity in surgical timing on treatment protocols relying on INRG staging.Conclusions Our findings mirror changes in practice patterns globally.We found an increase in minimally invasive approaches but did not find a difference in the role of the surgeon under the INRG staging system.