Most nations have a national security policy for protection in case of a man-made external attack; some nations, for example, base their security policy on the concept of nuclear deterrence. Paradoxically, few modern nations have a national health security policy in case of an attack, not by a human enemy, but by a natural pathogen or a weaponized man-made bio-attack. Only highly developed countries have the resources and policies in place in case of sudden outbreaks of viral or bacterial mutation arising spontaneously outside man-made bioweapons, which could be highly lethal and infectious. A unique consequence of the COVID-19 pandemic is that it has prompted the scientific community to contemplate the development of healthcare logistics and infrastructures that will tackle possible future pandemics, perhaps in a similar fashion to facing a war or an external attack. Biomedical scientists, armed with new biological techniques, have redirected their efforts to improve the production of new vaccines and drugs to combat the spread of such pathogens. New pandemics might not be caused by viruses such as the coronavirus SARS-CoV-2, the causative agent of COVID-19, but by other dangerous pathogens, as for example methicillin-resistant Staphylococcus aureus or bacteria linked to water and food sanitation. Multi-drug resistance bacteria as well as newly mutated bacteria may infect humans and animals. The infections they may cause would be harder to treat than those caused by non-resistant bacteria. Inevitably, antibiotic resistance will lead to high mortality, expensive medical logistic, infrastructure, and hospitalization. The recent COVID-19 and previously the Ebola and Zika outbreaks have demonstrated how fast infectious diseases can spread, and underline the imperative need for having rapid response vaccine on demand technology in place. At present, we face several pandemic-like scenarios involving viruses such as the common cold; a complex infectious syndrome caused by any of over 200 viral pathogens in four groups, adenoviruses, coronaviruses, enteroviruses and rhinoviruses. Influenza, which usually occurs in winter outbreaks or epidemics, can become a pandemic, being an ever-present threat to human health. Hepatitis C, hepatitis B, and HIV/AIDS are also a human threat but have been contained by effective medical treatments and targeted pharmacological agents. Outbreaks of infectious diseases in the past, such as the earlier periodic occurrence of Yersinia pestis plagues or the H1N1 “Spanish flu” (1918-1919), can be used to inform present clinical practices and healthcare policies. In the United States, for example, three levels of potential severity, incorporated in influenza pandemic preparedness strategies, correspond to H1N1, H2N2 “Asian flu” (1957-1958), and H3N2 “Hong Kong flu” (1968-1969). These pandemics resulted in an estimated 675,000,[1] 86,000,[2] and 56,000,[3] excess deaths in the United States, respectively. One main contemporary concern in the context of pandemic influenza planning is bacterial pneumonia. Bacterial infection in conjunction with influenza A virus is thought to have led to most of the deaths during the 1918-1919 pandemic.[4] In current pandemic planning, effective antimicrobial drug measures and immunization are expected to substantially benefit public health. Thus, vaccination with polysaccharide and conjugate pneumococcal vaccines is considered part of a pandemic strategy.[5] Infectious pathogens spread rapidly; therefore, containment by public health measures cannot always bring pandemics under control. Instead, global vaccine programs resulting from biotechnological advances can be used to control the spread of the pathogens, induce herd immunity and reduce mortality rates. The best example, a landmark in the history of medicine has been the production of the SARS-CoV-2 specific vaccine, which was developed in less than a year. In the case of serious infectious disease, the assumption is that the capacity of biotechnology to make novel and effective vaccines could be used to trigger immunity in the population and hence herd immunity. However, this is not always possible, as in the case of HIV/AIDS, which is at present contained by prophylaxis and effective anti-retroviral drugs, and not by vaccination. One of the most urgent public health problems is the continuous spread of antimicrobial resistance, in particular antibiotic resistance and the lack of newly developed antibiotics. This threatens to undermine the efficacy of bacterial treatment worldwide. Even the appropriate use of antimicrobials contributes to the development of resistance, and it is compounded by their unnecessary and excessive use.[6] This is particularly the situation in many developing countries, where unregulated supply chains and the absence of a system for drug prescription[6,7] facilitate gross misuse. Additionally, the use of antibiotics as growth promoters during food-animal production has contributed to increased prevalence of bacteria resistant to many anti-microbials.[8] Despite the advances in vaccinology, vaccines have not been developed against bacterial pathogens such as Staphylococcus aureus, Chlamydia trachomatis, Helicobacter pylori and Mycobacterium tuberculosis, to name a few. An example of a successful recent method for creating a vaccine against bacteria is the application of RNA technology, which was used to raise a vaccine against the plague bacterium Y. pestis, a gramnegative bacterium related to Yersinia pseudotuberculosis and Yersinia enterocolitica. This new technology could be applied to other bacterial pathogens, including novel pathogens resulting from the evolution of nonpathogenic bacterial taxa. Advances in nanoparticle-based vaccines offer a new avenue for rapid development of antibacterial vaccines[9]. For example, several polymer and lipid-based nanocarriers enhance the immunogenicity of oral vaccines enhancing mucosal and systemic immune responses. In order to prevent the impact of an outbreak mediated by a novel bacterium strain it is imperative to develop new antibiotics able to contain the spread of bacteria into the population and to regulate the use of currently utilised antibiotics. Fewer original class of antibiotic are reaching clinical settings. One reason for this is the high development costs to discover and bring new antibiotics to market with uncertainty in the ability of pharmaceutical companies to recoup those costs. Progress toward the development of new antimicrobials has therefore been slow, with only a limited number available for general use to treat bacterial infections.[10,11] This is an acknowledged challenge with a number of public and private collaborations working towards finding new solutions to this problem. Encouragingly, the use of antimicrobial growth promoters is presently banned or restricted in many countries during foodanimal production. Recent interest in strategies to combat antibiotic resistance have tended to focus on the use of the CRISPR/Cas system to develop novel antimicrobials and on the activity of outer membrane-penetrating endolysins (Artilysins). CRISPR/Cas technology entails the application of short CRISPR RNAs (crRNAs) that guide CRISPR-associated (Cas) nucleases to destroy targeted nucleic acids. crRNAs are transcribed from the CRISPR array within which captured pieces of phage DNA are integrated as new spacers. The Cas9 protein is able to cut the chromosome of bacteria and kill them in a sequencespecific manner.[12,13] To deliver CRISPR/Cas antimicrobials an efficient delivery system is required, with bacteriophage packaging systems as a possible approach.[14-16] Currently, engineered endolysin-based Artilysins are being developed to combat multidrug resistant Gram-negative pathogens. Artilysins destabilize the cell wall of the bacteria and lyse the cells. This technology can act against both Gram-positive and Gram-negative bacteria. Linked to the development of novel vaccines, immunotherapy has emerged as a separate branch of medicine in the form of immuno-oncology protocols for the treatment of cancer. This approach mostly, but not entirely, bypasses the use of pharmacological agents and relies exclusively on immunological techniques and the capability of the host immune system to fight diseases. In the time scale of the development of modern medicine, immunotherapy for the treatment of human diseases is a relatively new approach. Today it offers a possible last resort avenue for the treatment of a number of cancer malignancies. There are several distinct protocols and techniques being applied in immunotherapy. These include monoclonal antibodies, the use of immune checkpoint inhibitors, adoptive T-cell transfer, cancer vaccines such as dendritic cell preparations, and the use of modulators of the immune system such as soluble factors, including cytokines. In turn, as the immunotherapeutic techniques evolve it should be possible to use these techniques to boost the immune system to combat microbial infections. The combined use of the above technologies in fighting bacterial infections is still in its infancy, and will most likely find applications in the near future. They could potentially be used in the prevention of an outbreak caused by a lethal pathogenic bacteria and hence, control the advent of future pandemics.

Objectives: The objective of the study was to understand the relationship between social and economic indicators of health and its association with hospitalization severity and mortality risk among ALL patients. Methods: In this retrospective study, hospitalizations with primary and secondary diagnosis were identified using International Classification of Diseases (ICD 10) codes (C91.00, C91.01, C91.02) of ALL in the National Inpatient Sample (NIS) between 2016 and 2018. Hospitalization outcomes such as LOS, mortality, severity and mortality risk, cost, diagnosis (NDX), number of procedures (NPR) were analyzed by race and ethnicity, household income, and patient location among patients with primary and secondary ALL diagnoses. Results: A total of 158090 hospitalizations were identified as meeting the inclusion criteria without missing cases with a primary or secondary diagnosis of ALL using ICD-10 codes. Severity risk at presentation varied from one area to the next, with the highest rate (per 10K) presentations in the New England region for both extreme likelihood (778) and extreme loss of function (2198) at presentation. Mortality and severity among uninsured patients were the second highest (614, 2193) compared to other payers. Extreme mortality risk at presentation was higher among African American (711), Caucasian (648), and Native American (612) populations compared to other racial and ethnic groups. Conclusion: The findings of this study suggest a relative decrease in presentation rate by year and higher mortality among specific groups-based demographics indicators. It also confirms the impact of advanced therapeutics and improved severity and mortality among younger populations with ALL compared to the older population.

Objective: Ho Chi Minh City (Vietnam) was seriously affected by the 4th COVID-19 outbreak. This study aimed to provide mental health care services for people through a psychological intervention model, called “PSYCARE.” The model included five MHC services: active and passive education, propagation, 24-h hotline consultation, online interventions/counseling, and crisis intervention. Methods: The entire workflow was implemented in the three steps under the leadership of the Ho Chi Minh City government: (1) Preparation and mobilization, (2) Multidisciplinary team establishment, and (3) Feedback mechanism, and project completion. By statistical method on service usage data of people during the outbreak, we evaluated the results as well as discussed the model’s effectiveness. Results: In 42 days of implementation, there were a total of 149 posts, 1660 shares in social networks with more than 4,000 interactions per week. A MHC handbook was published. Ten episodes of MHC radio and ten live TV programs were broadcast with more than 10,000 listening times. We successfully propagated 35 topics at 4 COVID-19 hospitals and 34 quarantine areas. A total of 2,069 hotline consultations were done. 1,382 cases were counseled online, and 145 one-on-one crisis interventions were done to three groups: COVID-19 infected/affected children and adults, vulnerable people, frontline medical, and military staff. Conclusion: The PSYCARE model has been proven to positively affect the general population’s mental health during the COVID-19 outbreak. Our framework and model could be used as an expert reference guide in providing effective psychological intervention in the COVID-19 pandemic.

Objectives: Myocardial ischemia is a lack of blood supply to myocardial tissue. Rapid reperfusion therapy is required to prevent myocardial infarction. However, ischemia and reperfusion contribute to myocardial and endothelial injury or ischemia-reperfusion injury (IRI). A pro-inflammatory cytokine interleukin-8 (IL-8/CXCL8) plays an important role in the activation of neutrophil accumulation and promotes endothelial dysfunction. Therefore, inhibition of IRI through the regulation of inflammation using a CXCL8 receptor inhibitor reparixin is an attractive target. The aim of this study is to evaluate the effect of reparixin on endothelial cell viability after IRI. Methods: Human vascular endothelial cells (EA.hy926) were cultured and pretreated with reparixin at concentrations of 0−1 μg/ml. To simulate ischemia, the cells were exposed to simulated ischemia solution for 60 min. Then, the cells were given complete medium as reperfusion followed by treatment with reparixin and incubated for 24 h. Cell viability was tested using MTT assay. Results: Percentages of cell viability of reparixin-treated groups of 0.0625 μg/mL (67.88 ± 7.82% control) and 0.125 μg/mL (84.28 ± 4.68% control) were significantly higher than that of the IR group (44.31 ± 4.64% control) at P < 0.05. The percentage of cell viability in the 0.125 μg/mL reparixin-treated group was not significantly different compared to the control. Conclusion: Pretreatment and treatment of endothelial cells with reparixin, which is a CXCL-8 receptor inhibitor, demonstrated a protective effect on cell viability after simulated ischemia-reperfusion. However, further studies to investigate the underlying mechanisms are needed.

Objectives: Although there are numerous drugs available for the treatment of gastric ulcers (GU), these drugs are not always effective. Antidepressant medications have been used for a variety of non-psychiatric indications, including antiulcer activity in various ulcer models. The purpose of this study was to compare the antiulcer effects of fluvoxamine and mirtazapine in two rat GU experimental models and to determine their relationship to antioxidant and antisecretory mechanisms. Materials and Methods: The antiulcer activities of various doses of fluvoxamine and mirtazapine on water immersion restraint stress (WIRS) and pyloric ligation-induced GU in rats have been studied against the positive control antiulcer drug famotidine. Various oxidative stress markers were evaluated. Results: Fluvoxamine and mirtazapine significantly protected against WIRS and pyloric ligation-induced gastric lesions, as evidenced by a dose-dependent decrease in ulcer index, myeloperoxidase (MPO) activity, lipid peroxidation, and an increase in prostaglandin E2, nitric oxide (NO), and reduced glutathione levels, as well as increased antioxidant enzyme activity. In the pyloric ligation model, fluvoxamine and mirtazapine improved GU more than famotidine. Furthermore, a 30 mg/kg dose of mirtazapine significantly improves both NO levels and MPO activity compared to famotidine. Conclusions: The results highlighted the relationship in correlating the antiulcer effect of drugs from different antidepressant classes across two animal GU models, implying that antidepressants that affected both norepinephrine and serotonin levels (mirtazapine) had a more potent antiulcer effect in WIRS-induced gastric model than drugs that only affected serotonin levels (fluvoxamine).

Objective: Dysmenorrhea is defined as menstrual pain that develops due to uterine menstrual contractions. When the literature is examined, there are a limited number of studies about the frequency of primary dysmenorrhea (PD), influencing factors, and complementary and alternative treatment methods (CAMs) in Turkey. In this study, the aim was to determine the risk factors for PD and the effect of CAM use on PD in female university students. Methods: The sample for this descriptive study consisted of 180 female students who met the inclusion criteria and agreed to participate in the study. Data were collected using a questionnaire. Data were evaluated using SPSS v.21 and are presented as frequency, percentage, mean, and standard deviation with Chi-square and Kruskal–Wallis analyses performed. Results: The prevalence of PD was found to be high in students (83.3%). When the distribution of students is examined according to risk factors affecting dysmenorrhea, the relationships between the history of early menstruation, history of menorrhagia, family history of dysmenorrhea, and the occurrence of dysmenorrhea were found to be statistically significant (P < 0.05). In addition, the relationships between smoking, regular consumption of caffeinated beverages, regular physical activity, and emotional problems with the prevalence of dysmenorrhea were found to be statistically significant (P < 0.05). The mean VAS score of the students was 5.99 ± 2.06. When the distribution of VAS mean scores according to CAM used by the students is examined, the most effective CAM in reducing PD was mind–body techniques (4.20±1.56) (P < 0.05). According to the students’ VAS score averages, the most effective mind–body techniques used to reduce PD were applying heat to the abdomen (4.33 ± 1.98) and taking a hot shower (4.61 ± 2.13); the most effective nutritional supplement and healthy lifestyle behavior was omega 3 supplementation (4.20 ± 1.56); and the most effective herbal drink was ginger (4.88 ± 1.61) (P < 0.05). Conclusion: Risk factors for PD included early menarche, menorrhagia, family history of PD, smoking, regular consumption of caffeinated beverages, and emotional problems. The most effective methods to reduce pain in PD were applying heat to the abdomen, taking a hot shower, omega 3 supplements, and ginger.

Objective: The intervention of physical therapy in pediatric oncology is currently transmuting from a view based on the restriction of physical stress to an approach that advocates the practice of cardiorespiratory and motor interventions that provide a better prognosis for the patient. The objective of this study is to carry out a systematic review and to identify studies that address the performance of physical therapeutic practices in pediatric cancer patients admitted to an intensive care unit (ICU). Methods: The stage of identification and selection of articles were carried out according to what was recommended by Preferred Reporting Items for Systematic Review and Meta-analyzes, on PubMed, Medline, and Scopus platforms, based on the PICO acronym, and were classified by the PeDRO quality scale. Results: A total of 19,820 articles were found and six were acceptable according to the inclusion and exclusion criteria of the study, accounting for a total of 634 patients evaluated in the respective study. Conclusion: There is a scarcity of studies that show the reality of physical therapy practice in pediatric and neonatal ICU, with a focus on cancer patients. Most of the articles found emphasize the physiotherapeutic approach in the management of ventilation in these patients. Within this context, they show positive outcomes with the highest number of discharges, reduced mortality, increased survival, and treatment of respiratory failure. In addition, the application of non-invasive ventilation modalities proved to be more prevalent and important, both in the variables mentioned above and in the prevention of complications, such as a lower rate of patients undergoing orotracheal intubation.

Objective: The objective of the study was to examine already published evidence on the level of physical activity and sedentary behavior in children during and after treatment for cancer. And, thusly to verify if patients are following the recommendations of the World Health Organization, United States Centers for Disease Control and Prevention and American College of Sports Medicine. Methods: The platforms for searches were EBSCO, Web of Science and PubMed. The keywords used were physical activity, sedentary behavior, children or adolescents with cancer. Results: Found 4572 articles. 16 satisfied the eligibility criteria. The most children of whom had a low level of physical activity and a high level of sedentary behavior. Conclusions: We conclude that this population showed an increase in sedentary behavior. And, it was also observed that does not have specific recommendations for this population. Already, the recommendations used for the healthy children and for chronic patients are not ideal for this population. Therefore, it is demonstrated that specific recommendations must be created for this population.

Pigmented villonodular synovitis (PVNS) is a rare and benign lesion of unknown cause. Most cases reported in adult age patients. The diagnosing of PVNS is more difficult in old age patients and might be confused with osteoarthritis. This article reviews detailed history, examination, and investigations of 79 years-old male patient with 5 years history of right knee pain and deformity. The patient was diagnosed with PVNS, and total synovectomy was performed, followed by constrained total knee arthroplasty. The present report aimed to highlight that the total synovectomy with total knee arthroplasty is a viable option with the advantage of favorable outcome in treating patients with PVNS associated with advanced osteoarthritis.