Clinical Virology

Guidelines were obtained from France, Germany, Italy, Netherlands, Poland, Portugal, Sweden and the UK. Most guidelines recommend neuraminidase inhibitors over M2 inhibitors, but three countries were unclear or suggested M2 inhibitor use in some circumstances. Clinical ...

Background: Molecular techniques are established as routine in virological laboratories and virus typing through (partial) sequence analysis is increasingly common. Quality assurance for the use of typing data requires harmonization of genotype nomenclature, and agreement on target genes, depending on the level of resolution required, and robustness of methods. Objective: To develop and validate web-based open-access typing-tools for enteroviruses and noroviruses. Study design: An automated web-based typing algorithm was developed, starting with BLAST analysis of the query sequence against a reference set of sequences from viruses in the family Picornaviridae or Caliciviridae. The second step is phylogenetic analysis of the query sequence and a sub-set of the reference sequences, to assign the enterovirus type or norovirus genotype and/or variant, with profile alignment, construction of phylogenetic trees and bootstrap validation. Typing is performed on VP1 sequences of Human enterovirus A to D, and ORF1 and ORF2 sequences of genogroup I and II noroviruses. For validation, we used the tools to automatically type sequences in the RIVM and CDC enterovirus databases and the FBVE norovirus database. Results: Using the typing-tools, 785(99%) of 795 Enterovirus VP1 sequences, and 8154(98.5%) of 8342 norovirus sequences were typed in accordance with previously used methods. Subtyping into variants was achieved for 4439(78.4%) of 5838 NoV GII.4 sequences. Discussion and conclusions: The online typing-tools reliably assign genotypes for enteroviruses and noroviruses. The use of phylogenetic methods makes these tools robust to ongoing evolution. This should facilitate standardized genotyping and nomenclature in clinical and public health laboratories, thus supporting inter-laboratory comparisons.

Impairment of varicella zoster virus (VZV)-specific cell-mediated immunity, including impairment due to immunosenescence, is associated with an increased risk of developing herpes zoster (HZ), whereas levels of anti-VZV antibodies do not correlate with HZ risk. This crucial role of VZV-specific cell-mediated immunity suggests that boosting these responses by vaccination will be an effective strategy for reducing the burden of HZ. Other strategies focus on preventing the major complication of HZ-post-herpetic neuralgia. These strategies include pre-emptive treatment with drugs such as tricyclic antidepressants, anticonvulsants and analgesics.

Background: Subtyping of human papilloma virus (HPV) may enhance the precision of vaginal cytological assessments and will be important for investigating the effect of the recently introduced vaccine against types 16 and 18. Objectives and study design: To evaluate an in-house real-time PCR targeting HPV types 16-18-31-33-35-39-45-51-52-56-58-59-6-11, by analysing 107 liquid-based cytology specimens representing various degrees of dysplasia. Results: In all, 71 samples were HPV positive, with multiple types present in 37 (52%). Comparison with Roche Linear Array on a subset of 24 of these 71 samples showed a good agreement. One or several types were detected in 17/17 (100%) samples with cervical intraepithelial neoplasia grade 2-3 (CIN 2-3), 16/19 (84%) with CIN 1, 32/43 (74%) with Atypical Squamous Cells of Undetermined Significance (ASCUS), and in 6/28 (21%) with benign cytology. Estimates of mean viral load were lower in CIN 1-3 than in ASCUS (≈4000 vs. ≈25,000 copies/1000 cells), and clearly lower in samples with benign cytology (≈50 copies/1000 cells). Conclusion: The HPV rates in groups with different degrees of dysplasia agrees with previous reports and support a strong link between types 16/18 and severe dysplasia. The high rate of multiple type infection might influence the outcome of HPV vaccination. The possible importance of viral load should be further studied.

Background: Human enterovirus 71 (EV-71) emerged as a significant pathogen able to cause large outbreaks involving severe neurological cases and children fatalities in Asia. Objectives: To describe epidemiology of EV-71 infections in France. Study design: Fifty-nine patients admitted in 12 different hospitals from 1994 to 2009 were included. The entire VP1 coding gene of 58 EV-71 strains was sequenced and phylogenetic analyses were performed to assign strains to genogroups/subgenogroups and to compare French isolates to European and worldwide isolates. Results: The median age of the patients was 1.04 years (9 days to 7 years). Among 46 documented EV-71 infections, 39 were self-limited. Seven children developed severe sepsis-like, respiratory or neurological complications. Among them, 2 children died from acute respiratory distress syndrome. All the EV-71 strains belonged to genogroup C: 31 isolates belonged to subgenogroup C1, 26 to subgenogroup C2 and 1 to subgenogroup C4. All the strains were genetically related to other European strains isolated at the same period of time. Although C1 isolates were predominant between 1994 and 2005, C2 strains have been predominant since 2007. No association was found between any genotype and the age or the clinical symptoms. Conclusions: The C4 subgenogroup, which was associated with large outbreaks in China, did not spread in France. It is important to monitor more carefully the EV-71 strains circulating in France to detect the introduction of new genetic variants that could be associated with major outbreaks.

Background: Worldwide, many countries test for HIV infection using combination assays that simultaneously detect p24 antigen and HIV antibodies. One such assay, the ARCHITECT ® HIV Ag/Ab Combo Assay (ARCHITECT), has recently been approved by the Food and Drug Administration (FDA) for use in the United States. Objective: To evaluate the performance of ARCHITECT on well-characterized specimens from four CDCfunded studies. Study design: We evaluated 3386 HIV-infected, 7551 HIV-uninfected, and 58 acute HIV infection (AHI) specimens. HIV-infected specimens were repeatedly reactive by enzyme immunoassay (EIA) and Western blot (WB) or positive by nucleic acid amplification testing (NAAT). HIV-uninfected specimens were EIAand NAAT-negative. AHI specimens were seronegative or indeterminate (using antibody-based EIAs, rapid tests or WB) and NAAT-positive. All specimens were de-identified and sent to Abbott Diagnostics for testing with ARCHITECT. ARCHITECT test results were compared to original study characterizations and were used to assess overall sensitivity and specificity and also sensitivity for AHI. ARCHITECT falsepositive specimens with sufficient quantity were retested. Results: Based on results from the initial ARCHITECT test, sensitivity was 99.94% (95% confidence interval [CI]: 99.79, 99.99) and specificity was 98.78% (95% CI: 98.51-99.01). Repeat testing resulted in corrected specificity of 99.50% (95% CI: 99.31, 99.64). Also, 48 AHI specimens (83%) were detected by this screening assay. Conclusion: The sensitivity and specificity of the ARCHITECT combination assay are very high and most AHIs were detected by the assay. Use of Ag/Ab combination assays may improve the number of AHIs identified relative to existing FDA-approved HIV-antibody only based serologic assays, particularly in high incidence populations.

Objecti6e: Summary of the studies carried out by the IARC on HPV and cervical cancer is presented. Results: the first one was the international prevalence survey of HPV types in invasive cervical cancer (ICC) conducted in up to 22 countries. Overall, 99.7% of 1000 cases with histologically confirmed ICC were also shown to be HPV DNA positive using the GP5 +/GP6+ or E7 primers, indicating that HPV is a necessary cause of cervical cancer. The most prevalent HPV types were HPV 16 (53%), HPV 18 (15%), HPV 45 (9%), HPV 31 (6%) and HPV 33 (3%). HPV 16 was the most common type in all geographical regions, followed by HPV 18 that was particularly, common in SouthEast Asia. The second set of studies included case-control studies carried out in 13 countries. They included about 2000 cases and 2000 controls. Positivity, for any HPV DNA yielded a pooled odds ratio (OR) of 70. The association was equally strong for both squamous cell (OR = 74) and adenocarcinoma (OR =50) and for HPV 16 and 18 as well as for the less common HPV types. Our results indicate that in addition to HPV 16 and 18, HPV 31, 33, 35, 45, 51, 52, 58 and 59 now can be considered as carcinogenic. The third group of studies is aimed to determine the HPV DNA prevalence in random, age-stratified (by 5 years, 15-19 to 65 +) subsamples (1100 women) of the general population. Two age-peaks (B 25 and \ 59 years), have been found in some countries (Costa-Rica, Mexico, Colombia) but not in all (Argentina). Whether the second peak is due to viral reactivation, variations in screening or represents a birth-cohort effect remains to be determined. The distribution of the most prevalent HPV types in the general population (HPV 16, 18, 45, 31, 58, 33, 35) resembles that for cervical cancer cases. Conclusions: our studies provide the most solid epidemiological evidence, to conclude that HPV is not only the central cause of cervical cancer worldwide but also a necessary cause.

Respiratory syncytial virus rapid antigen detection tests (RADT) are used widely. RADT exhibited high specificity (97%) and moderate sensitivity (80%) compared with reverse-transcriptase polymerase chain reaction in 720 hospitalized children <3 years old. Older age, prolonged symptoms, and respiratory syncytial virus genotype-B infection were significantly associated with false-negative results of RADT.

This review summarizes major issues of verification and validation procedures and describes minimum requirements for verification and validation of diagnostic assays in clinical virology including instructions for CE/IVD-labeled as well as for self-developed ("home-brewed") tests or test systems. It covers techniques useful for detection of virus specific antibodies, for detection of viral antigens, for detection of viral nucleic acids, and for isolation of viruses on cell cultures in the routine virology laboratory.

Since August 2014, an increase in infections caused by enterovirus D68 (EV-D68) was reported in the USA and Canada, for the most part in children presenting with severe respiratory symptoms. To determine whether an increase in severe EV-D68 respiratory infections was observed in our region. Samples from patients with respiratory symptoms were screened for viral pathogens, including rhinovirus and enterovirus. Subsequently, samples positive for rhinovirus and enterovirus were routinely sequenced for phylogenetic analysis. Furthermore, an additional method was used to detect EV-D68 specifically. During the first three quarters of the year 2014, 1896 respiratory samples were analyzed; 39 (2%) of them tested positive for enterovirus. Eighteen samples tested positive for EV-D68, obtained from 16 different patients admitted to our hospital. Eleven were children below the age of 18, of whom five children needed intensive care treatment. The remaining five samples were from adults, who all ...

Aims: Glial fibrillary acidic protein (GFAP)-d i san o v e l isoform that differs in its C-terminal sequence from other GFAP isoforms. Previous studies suggest restriction of expression to the subpial layer, subventricular zone and the subgranular zone astrocytes, with an absence in pathological conditions causing reactive gliosis. GFAP-d is speculated to have roles in regulation of astrocyte size and motility and a subpopulation of GFAP-d-positive glia may be multipotent stem cells. The aim of this study was to investigate its expression in common causes of lesionrelated refractory epilepsy. Methods: Hippocampal sclerosis (HS), focal cortical dysplasia (FCD) type IIB, cortical tuberous sclerosis (TSC) lesions, gangliogliomas, grey matter heterotopias and hemimegalencephaly from a wide age range of patients using both surgical and post mortem tissue specimens were studied. Results: GFAP-d expression was observed in CA4 and CA1 astrocytes in HS with less frequent labelling in the granule cell layer, even where granule cell dispersion was present. No significant labelling was noted in the subiculum in HS cases or in any subfields in non-HS epilepsy cases. Balloon cells in FCDIIB and hemimegalencephaly, giant cells in TSC and the astrocytic component of gangliogliomas showed immunoreactivity, colocalizing with conventional GFAP. No neuronal expression for GFAP-d was seen in any of the pathologies. Quantitative analysis in 10 FCDIIB and five TSC cases revealed greater numbers of GFAP-d-positive balloon cells than conventional GFAP. There was no GFAP-d expression within nodular heterotopia. Conclusions: GFAP-d expression patterns in HS overall appears to mirror regional reactive gliosis. It is a useful marker for the demonstration of balloon cells in FCD and TSC, which may be relevant to their abnormal size and localization. The lack of GFAP-d within heterotopia supports their composition from cells destined for deeper cortical layers.

Context: Infection rates in the intensive care unit (ICU) have been found to be the highest among all hospital-acquired infections. Aim: To determine the prevalence of current bacteriological profile in blood cultures along with their antibiogram from ICU patients.

Background: Hepatitis delta virus (HDV) RNA viral load measurement is critical in diagnosis and monitoring the response to antiviral treatment. Objectives: Our aim is to design a real time PCR method for accurate quantitation of HDV RNA in clinical specimens using an armored RNA as external standard, and an intrinsic internal control. Study design: A plasmid bearing delta antigen region of genotype I HDV genome was used to develop an armored RNA. Serial dilutions of the armored HDV RNA standard with 10 12 copy/mL were used as standards for quantitation. A primer-probe set derived from HDAg region was used in one step EZ RT PCR kit chemistry which uses rTth enzyme allowing reverse transcription and polymerization in the same tube. The kit also uses the advantage of uracil-N-glycosylase (UNG) enzyme treatment to prevent PCR contamination. Results: The established assay has a dynamic range of 10 2 -10 11 copy/mL with a PCR efficiency of 96.9%. Detection limit was 858 ± 32 copy/mL with 95% confidence interval. Intra-and inter-assay variabilities were low for high, medium and low levels of viremia. Incorporation of freely circulating GAPDH in serum into the assay as an intrinsic internal control prevented false negative results and failures in PCR amplifications due to inhibitors, inefficient extraction procedures or enzymatic reactions. Conclusion: In conclusion, this study defines a novel assay for sensitive and reliable quantification of HDV RNA using an armored HDV RNA as a standard and GAPDH in plasma or serum as an intrinsic internal control in a single tube.

کابینت های ایمنی زیستی ( )BSCsفضاهای کاری محصور با هود تهویه هستند که به منظور نگهداری
میکروارگانیسم های بیماریزا در طی فرآیندهای میکروبیولوژیکی طراحی شده است.
هدف اصلی کابینت های ایمنی زیستی محافظت از پرسنل آزمایشگاه و محیط زیست در برابر میکروارگانیسم
بیماریزا است زیرا ممکن است در هنگام کار با چنین میکروارگانیسم هایی ، آئروسل ها ایجاد شوند. این ها فقط
برای موجودات خاص گروه خطر و برای فرآیندهایی که ممکن است منجر به تشکیل آئروسل شوند استفاده می
شود.

Human papillomaviruses (HPVs) comprise more than 100 genotypes. The mucosal types can be divided into high-risk and low-risk (LR) types depending on the associated disease risk. HPV infection is mainly diagnosed by molecular methods, since reliable serological tools are not available and culture of the virus is not possible. Accurate molecular diagnostic techniques that can be used to inform patient management and follow-up after treatment are now available for detection and identification of HPV. The diagnosis of HPV infections in patients at risk of disease in a clinical setting requires a different approach from that used for epidemiological studies, vaccination trials and natural history studies. This review describes the different molecular methods available for HPV detection and genotyping and their possible clinical utility.

This review summarizes major issues of verification and validation procedures and describes minimum requirements for verification and validation of diagnostic assays in clinical virology including instructions for CE/IVD-labeled as well as for self-developed ("home-brewed") tests or test systems. It covers techniques useful for detection of virus specific antibodies, for detection of viral antigens, for detection of viral nucleic acids, and for isolation of viruses on cell cultures in the routine virology laboratory.

Enterobacter sakazakii and other Enterobacter species have caused foodborne illnesses through consumption of a variety of foods, including infant foods. The prevalence of E. sakazakii and other Enterobacter sp. in infant food and milk formula, milk powder, cereal products, spices, sugar and food production environments were studied. A total of 106 samples were tested for the presence of E. sakazakii and other Enterobacter sp. The presence of E. sakazakii and Enterobacter sp. was detected using the FDA enrichment procedure and a chromogenic medium. E. sakazakii was isolated from 2/15 infant food formula, 2/8 infant milk formula, 1/18 cereal products. However none of the powder milk, spices, sugar and environmental samples were positive for E. sakazakii. E. agglomerans was isolated from infant food formula, infant milk formula, milk powder, cereal products, spices and environmental samples. E. cloacae was isolated from infant milk formula.

Zika virus is a mosquito transmitted flavivirus belongs to family Flaviviridae, which became the focus of an ongoing pandemic and public health emergency all around the world. Zika virus (ZIKV) has 2 lineages: African and Asian. Mosquito-borne flaviviruses are thought to initially replicate in dendritic cells and then spread to lymph and therefore the blood stream. Risk for infection through blood transfusion, sexual practices, and perinatal transmission exists. The potential routes of perinatal transmission are all over delivery, breastfeeding and by close contact between the mother and newborn baby. ZIKV is often misdiagnosed with other infection like Dengue and Chikungunya because of similar clinical manifestation. The association between these conditions with Zika virus infection is still not confirmed and is under assessment. Since ZIKV has neither an effective treatment nor a vaccine is available, therefore the public health authority focuses on preventing infection, particularly in pregnant women and virus transmitted region. Zika infections in adults may result rarely in Guillain-Barre syndrome. World Health Organization and different health officers are working on the development of new projects and mosquito control methods to cope up with infection as there's very less literature present on the pathologic process of the Zika virus to help interpret the clinical disease spectrum and target treatments to minimize or prevent infection. WHO/PAHO encourages the countries to set up and retain Zika virus infection detection, clinical management and community assertion strategies to decrease transmission of the virus. This review describes the current understanding of the epidemiology, transmission, clinical characteristics, and diagnosis of Zika virus infection, as well as the future outlook with regard to this disease.

Herpes labialis is a common skin infective condition, worldwide, which is primarily caused by HSV-1. Recurrent episodes of herpes labialis, also known as cold sores, can be frequent, painful, long-lasting and disfiguring for infected patients. At present, there are two types of antivirals for the treatment of herpes labialis, topical and oral, which are available over the counter or as prescription-only. The aim of antiviral therapy is to block viral replication to enable shortening the duration of symptoms and to accelerate healing of the lesions associated with herpes labialis. This review examines the evidence for the effectiveness of current topical and oral antivirals in the management of recurrent episodes of herpes labialis. In most countries, oral antivirals for herpes labialis are available as prescription-only. However, in early 2010, the oral antiviral famciclovir was reclassified from prescription-only medicine to pharmacistcontrolled status in New Zealand. The benefits and risks associated with moving an antiviral therapy for herpes labialis from prescription-only to pharmacist-controlled status are reviewed here, and the implications for patients, general physicians and pharmacists are considered.

Asthma is a disease characterized by wide variations in
pathogenesis that cause resistance to flow in intrapulmonary
airways. The dramatic changes in the architecture of the airway
walls are usually connected to allergic reaction or other forms of
hyper sensitivity, causing marked spasms that lead to difficulty in
breathing. It is possible to relieve or remove the symptoms in the
majority of patients by adopting the clinical guidelines for
pharmacotherapy of asthma which include inhaled corticosteroids,
long and short acting beta agonists, muscarinic antagonists,
leukotriene modifiers, xanthine drugs and some allergy medicines.
The proper use of these agents can aid in reducing or reversing
many symptoms of asthma. Certain methods of using medicines,
for example the correct use of the inhaler for relief and
maintenance therapy, are also associated with a significant
reduction in symptoms. This can be achieved by a pharmacist’s
intervention that can provide a detailed understanding of the
current rational drug choices and proper medication use to the
patient. Nowadays massive resources are being ploughed into
research in a concerted effort to halt the progress of this illness
that can strike in all ages.

Since millions of years, parasites had and still have to survive the struggle for life competed with individuals of their own species as well as with higher numbers of competitors. A note‐worthy quote of the overall biodiversity found in any ecosystem can be attributed to parasitism since every species of animal is parasitized by at least another organism. The disease burden caused by parasites is significant and represents a challenging health problem, mainly in tropics and in developing countries. Chemical control is mostly effective, but there are some major limitations to face, including toxicity on non target organisms, the rapid development of drug and pesticide resistance, and high operational costs. Consequently, there is an urgent need for discovery of new, eco-friendly, and effective drugs. For centuries, medicinal and aromatic plants have been used to combat parasites in traditional medicine and, in many parts of the world, are still used for this purpose. Besides the introductory chapter “Back to the Future: Solutions for Parasitic Problems as Old as Pyramids," this book discusses, in eight chapters, three major topics of natural parasitic control as biological, botanical, and miscellaneous control strategies. Biological Control: A chapter reviews natural enemies or biological control agents including predators, parasites and parasitoids, and pathogens (covering viruses, bacteria, protozoa, fungi and nematodes); the effect of biocontrol agents on native biodiversity; case studies of the successful implementation of biocontrol methods; and challenges facing biological control strategies and their future perspectives. Botanical Control: Three chapters highlight the advantages of the use of plant-derived compounds such as essential oils, plant extracts, and Mexican plants, as an alternative way to control and prevent parasites of humans, livestock, and wildlife. Miscellaneous Biorationals: The last four chapters focus on other natural control methods including the benefits of involvement of gap junction proteins, permitting cellular communication in infectious diseases caused by parasites; lactoferricins (an iron-binding glycoprotein of the innate immune system) against intestinal parasitic diseases; plasmepsin for antimalarial drug development; and, finally , vaccination against Trichinella spiralis, highlighting its potential, limitations, and future perspective. Natural product research shows a promising potential in finding new lead structures be‐ sides rational drug design. The editors of this book have a special research interest in natural control of parasites as well as arthropod pests. Therefore, we enthusiastically present this book with numerous updates on topics of vigorous timely research. This textbook is designed for students and teachers at the same time. It emphasizes principles about natural control of the major parasites of humans, domestic animals, and crops. As always, we have strived for readability, enhancing chapters with figures and tables. Essential terms are defined and lists of abbreviations are provided. Numbered references at the end of each chapter make supporting data and further study easily accessible. Clear labeling makes all illustrations approachable and self-explanatory to the readers. We thank the continuing efforts of the contributors to this book, exposing their thought about weaknesses in the biology of parasites and how nature contributes to solving parasitic problems. This knowledge, in turn, suggests safe materials for parasitic control. Then, we are grateful to the efforts of all coworkers of each group who kindly provided text and figures in their final format. Our sincere thanks are directed to Mr. Edi Lipovic, InTech Publishing Process Manager; Prof. Dr. Azza A. Moustafa, Research Institute of Medical Entomology, Egypt; Galal Abouelella, British University in Egypt; colleagues at Benha University, Egypt; Prof. Dr. Adel Shaheen, Department of Fish Diseases and Management, Faculty of Veterinary Medicine; Dr. Ahmed Radwan, Department of Parasitology, Faculty of Veterinary Medicine; and Prof. Dr. Abdou Mahdi and Prof. Dr. Mohamed Hafez, Plant Pathology Department, Faculty of Agriculture, for their valuable support and advice.

Rising and remerging pathogens are worldwide difficulties for open health.1 Coronaviruses are wrapped RNA infections that are dispersed extensively among people, different warm-blooded creatures, and flying creatures and that cause respiratory, enteric, hepatic, and neurologic diseases.2, 3 Six coronavirus species are known to cause human illness like 229E, OC43, NL63, and HKU1, SARS – CoV and MERS – CoV.4 Given the high predominance and wide circulation of coronaviruses, the huge hereditary decent variety and successive recombination of their genomes, and expanding human–creature interface exercises, novel coronaviruses are probably going to develop intermittently in people attributable to visit cross-species contaminations and incidental overflow events.5, 6 On January 30, World Health Organization (WHO) pronounced the ebb and flow flare-up that began in Wuhan, China as a Public Health Emergency of International Concern, while prescribing against movement or exchange interruptions to and from China.7 The progressing pandemic of coronavirus ailment 2019 (COVID-19) is brought about by extreme intense respiratory disorder coronavirus 2 (SARS-CoV-2).8 As of 12 April 2020, in excess of 1,777,515 instances of COVID-19 have been accounted for in more than 200 nations and regions, bringing about in excess of 108,862 passings.

An overview of what constitutes or signifies a "virus" has been presented. It is explicated that viruses are NOT solar organic living organisms, as inconsistent with what epitomizes a living organic organism, they are: (1) void of a cellular structure, (2) they do not have a digestive nor respiratory system, (3) they do not procreate but are only capable of replication, and that only occurs when they invade the cellular body of an organic living organism and manage to use the genetic material of their invaded host to replicate themselves and multiply while causing genetic mutation of their invaded host, and (4) strictly speaking, they cannot self-evolve and can only mutate with the aid of the genetic material of the cellular structure of the organic organism pf their host. There have been several different theories proposed by biologists, virologists, and generally scientists, with regard to speculations of whether viruses can be construed as living organisms, but all are problematic with regard to their arguments presented. However, one thing is quite certain, that viruses can only exist in the environments that living organism thrive. In this respect, they can best be considered as parasitic 'replicators,' not suggesting that they necessarily feed upon their hosts, but need the genetic materials of their host in order to mutate their host cells to replicate. And, although nefarious viruses can cause infection in the organic body of their host eventuated by triggering the immune response of their host body causing illness and even death of their host, not all viruses are necessarily bad. In fact, viruses may be

ABSTRACT
Background: For the past two decades, Acinetobacter spp. have emerged as an important
pathogen globally in various infections. Objectives: This study was conducted to determine the
frequency, risk factors, and antibiotic resistance pattern of Acinetobacter spp. from various clinical
samples. Materials and Methods: This retrospective, hospital record–based, cross‑sectional study
included a total of 8749 clinical samples collected from patients at a tertiary care hospital in Odisha,
India from July 2010 to December 2012. The samples were processed and identified by standard
protocol. The Acinetobacter isolates were tested for antibiotic resistance by Kirby‑Bauer disk
diffusion method [according to the Clinical and Laboratory Standards Institute (CLSI) guidelines].
Results: From 8749 clinical samples, 4589 (52.5%) yielded significant growth and only 137 (3%,
137/4589) Acinetobacter spp. were isolated. Maximum (56.9%) isolates were obtained from pus/
swab, followed by blood (13.1%) and urine (12.4%). Elderly age, being inpatients, longer duration of
stay in the hospital, associated co‑morbidity, and invasive procedure were found to be significant risk
factors in the setup investigated (P is less than 0.05). Out of 137 isolates, 75 (54.7%) were resistant
to more than three classes of antibiotics (multidrug resistant) and 8 (5.8%) were resistant to all
commonly used antibiotics (pan‑drug resistant). Majority of the isolates were sensitive to imipenem,
meropenem, and piperacillin/tazobactam, and showed resistance rates of 19%, 22%, and 23%,
respectively. All eight pan‑drug resistant isolates were 100% sensitive to colistin. Conclusion: This
hospital‑based epidemiological data will help to implement better infection control strategies and
improve the knowledge of antibiotic resistance patterns in our region.
Key words: Acinetobacter species, antibiotics, frequency, resistance, risk factors

This extract presents 100 pages from the newly revised and enlarged Fourth Edition of 'AVD: The Anti-Viral Diet', which shares the results from the most recent, cutting-edge scientific research into the anti-viral properties of widely available foods - as well as of some rarer ingredients. Most significantly, that report confirms - among other conclusions - that good nutritional status increases vaccine efficacy and decreases the probability of suffering the dangerous side effects of some vaccines.

This extract includes copious evidence regarding eight dietary ingredients from the 'Anti-Viral Diet' and a key extract on the project's proposal for an 'Anti-Viral Five-a-Day'. This extract includes 16 full-colour photographs.

The 'AVD' publication presents the general theory of an 'Anti-Viral Diet' and also the evidence from over 2000 scientists and medical researchers confirming the anti-viral and immunomodulatory properties of many dietary ingredients. At the core of 'AVD' is a database of 52 Anti-Viral Ingredients  with detailed specifications and 104 colour photographs. Key info is provided on each of the identified ingredients, including against which viruses they have exhibited potent effects, how they 'boost' the Immune System, as well as key data about Recommended Daily Allowances. Citations and extracts from over 1000 research articles enables a broad range of scientists to speak in their own words about key discoveries in nutritional immunology and anti-viral dietetics. Every section includes research findings from at least two dozen articles (mainly from peer-reviewed journals) corroborating anti-viral qualities exhibited by that ingredient.

With kind permission of the publishers LIVING TIME™ Books. Copyright © LTB™ 2020-22.

Herpes zoster oticus is caused by varicella-zoster virus, which causes chicken pox and shingles1, 2. Shingles results from a reactivation of a latent infection by the varicella zoster virus. The cause of the reactivation is unclear but it is common in patients with neoplasm or after trauma), AIDS and other immunocompromised states3. It is a delayed expression of the virus1,3. It is thought to be a cranial polyneuropathy4 and is said to be the second most common cause of atraumatic peripheral facial paralysis5. Here, we report a case of herpes zoster oticus (Ramsay-Hunt Syndrome) in mid-trimester of pregnancy in a young nulliparous woman, with multiple dermatomal involvement.

Abbreviations: Anti HBc, antibody to hepatitis B core protein is a marker of current (in the presence of HBsAg) or past infection with HBV; Anti HBe, antibody to hepatitis e antigen can be a marker for low infectivity (in the presence of HBsAg, especially in wild type infection); Anti HCV, antibody to HCV is a marker of current (in the presence of HCV RNA) or past infection with HCV; CDC, centres for disease control; EPP, exposure prone procedures is the term for invasive procedures where there is potential for contact between the skin of the HCW and sharp surgical instruments, needles or sharp tissues in body cavities or poorly visualised/confined body sites; HBeAg, hepatitis B e antigen is a marker of level of infectivity; HBsAg, hepatitis B surface antigen detectable in serum in the majority of HBV infected patients; HBV, hepatitis B virus; HBV DNA, hepatitis B nucleic acids. Can be used to monitor infectivity Journal of Clinical Virology 27 213 Á/230 www.elsevier.com/locate/jcv 1386-6532/03/$ -see front matter #

Vitamin D has long been recognized as essential to the skeletal system. Newer evidence suggests that it also plays a major role regulating the immune system, perhaps including immune responses to viral infection. Interventional and observational epidemiological studies provide evidence that vitamin D deficiency may confer increased risk of influenza and respiratory tract infection. Vitamin D deficiency is also prevalent among patients with HIV infection. Cell culture experiments support the thesis that vitamin D has direct anti-viral effects particularly against enveloped viruses. Though vitamin D's anti-viral mechanism has not been fully established, it may be linked to vitamin D's ability to up-regulate the anti-microbial peptides LL-37 and human beta defensin 2. Additional studies are necessary to fully elucidate the efficacy and mechanism of vitamin D as an anti-viral agent.

An acute and often severe respiratory illness emerged in southern China in late 2002 and rapidly spread to different areas of the Far East as well as several countries around the globe. When the outbreak of this apparently novel infectious disease termed severe acute respiratory syndrome (SARS) came to an end in July 2003, it had caused over 8000 probable cases worldwide and more than 700 deaths.

This 100-page Sampler from the fully revised Academy Edition of 'AVD: The Anti-Viral Diet' provides a helpful cross-section of this new publication by academic researcher Edouard d'Araille. In this extract alone, over 100 academic research articles, studies and trials are offered in support of the handful of anti-viral ingredients that are included here. 'AVD' is a three-stage project of which this publication documents the findings of Stage One in regards to what is known about the anti-viral dietary components up to now. The book as a whole contains the work of over 1000 scientists in support of an anti-viral diet and this corroborative research covers a period of more than 50 years. The majority of ingredients discussed in this diet have been evidenced to have significant effects against COVID-19, both in terms of their anti-virality or due to immunomodulatory qualities. This extract from the 3rd Academy Edition of 'AVD' is provided by courtesy of Living Time™ Books.

Las bacterias únicamente son poseedoras de fotosistemas I, de manera que al carecer de fotosistemas II no están capacitadas para usar al agua como dador de electrones, y en consecuencia, no producen oxígeno al realizar la fotosíntesis. En función de la molécula que emplean como dador de electrones y el lugar en el que acumulan sus productos, es posible diferenciar tres tipos de bacterias fotosintéticas: las sulfobacterias purpúreas se caracterizan por emplear sulfuro de hidrógeno (H2S) como dador de electrones y por acumular el azufre en su interior; las sulfobacterias verdes también utilizan al sulfuro de hidrógeno, pero a diferencia de las purpúreas no acumulan azufre en su interior; y finalmente, las bacterias verdes carentes de azufre usan materia orgánica, tal como ácido láctico, como donadora de electrones.