33 research outputs found
Clinical features and management of human monkeypox: a retrospective observational study in the UK
Background
Cases of human monkeypox are rarely seen outside of west and central Africa. There are few data regarding viral kinetics or the duration of viral shedding and no licensed treatments. Two oral drugs, brincidofovir and tecovirimat, have been approved for treatment of smallpox and have demonstrated efficacy against monkeypox in animals. Our aim was to describe the longitudinal clinical course of monkeypox in a high-income setting, coupled with viral dynamics, and any adverse events related to novel antiviral therapies.
Methods
In this retrospective observational study, we report the clinical features, longitudinal virological findings, and response to off-label antivirals in seven patients with monkeypox who were diagnosed in the UK between 2018 and 2021, identified through retrospective case-note review. This study included all patients who were managed in dedicated high consequence infectious diseases (HCID) centres in Liverpool, London, and Newcastle, coordinated via a national HCID network.
Findings
We reviewed all cases since the inception of the HCID (airborne) network between Aug 15, 2018, and Sept 10, 2021, identifying seven patients. Of the seven patients, four were men and three were women. Three acquired monkeypox in the UK: one patient was a health-care worker who acquired the virus nosocomially, and one patient who acquired the virus abroad transmitted it to an adult and child within their household cluster. Notable disease features included viraemia, prolonged monkeypox virus DNA detection in upper respiratory tract swabs, reactive low mood, and one patient had a monkeypox virus PCR-positive deep tissue abscess. Five patients spent more than 3 weeks (range 22–39 days) in isolation due to prolonged PCR positivity. Three patients were treated with brincidofovir (200 mg once a week orally), all of whom developed elevated liver enzymes resulting in cessation of therapy. One patient was treated with tecovirimat (600 mg twice daily for 2 weeks orally), experienced no adverse effects, and had a shorter duration of viral shedding and illness (10 days hospitalisation) compared with the other six patients. One patient experienced a mild relapse 6 weeks after hospital discharge.
Interpretation
Human monkeypox poses unique challenges, even to well resourced health-care systems with HCID networks. Prolonged upper respiratory tract viral DNA shedding after skin lesion resolution challenged current infection prevention and control guidance. There is an urgent need for prospective studies of antivirals for this disease
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Multiscale modelling of evolving foams
We present a set of multi-scale interlinked algorithms to model the dynamics of evolving foams. These algorithms couple the key effects of macroscopic bubble rearrangement, thin film drainage, and membrane rupture. For each of the mechanisms, we construct consistent and accurate algorithms, and couple them together to work across the wide range of space and time scales that occur in foam dynamics. These algorithms include second order finite difference projection methods for computing incompressible fluid flow on the macroscale, second order finite element methods to solve thin film drainage equations in the lamellae and Plateau borders, multiphase Voronoi Implicit Interface Methods to track interconnected membrane boundaries and capture topological changes, and Lagrangian particle methods for conservative liquid redistribution during rearrangement and rupture. We derive a full set of numerical approximations that are coupled via interface jump conditions and flux boundary conditions, and show convergence for the individual mechanisms. We demonstrate our approach by computing a variety of foam dynamics, including coupled evolution of three-dimensional bubble clusters attached to an anchored membrane and collapse of a foam cluster
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Analysis and applications of the Voronoi Implicit Interface Method
We analyze a new mathematical and numerical framework, the " Voronoi Implicit Interface Method" (" VIIM" ), first introduced in Saye and Sethian (2011) [R.I. Saye, J.A. Sethian, The Voronoi Implicit Interface Method for computing multiphase physics, PNAS 108 (49) (2011) 19498-19503] for tracking multiple interacting and evolving regions (" phases" ) whose motion is determined by complex physics (fluids, mechanics, elasticity, etc.). From a mathematical point of view, the method provides a theoretical framework for moving interface problems that involve multiple junctions, defining the motion as the formal limit of a sequence of related problems. Discretizing this theoretical framework provides a numerical methodolology which automatically handles multiple junctions, triple points and quadruple points in two dimensions, as well as triple lines, etc. in higher dimensions. Topological changes in the system occur naturally, with no surgery required. In this paper, we present the method in detail, and demonstrate several new extensions of the method to different physical phenomena, including curvature flow with surface energy densities defined on a per-phase basis, as well as multiphase fluid flow in which density, viscosity and surface tension can be defined on a per-phase basis.We test this method in a variety of ways. We perform rigorous analysis and demonstrate convergence in both two and three dimensions for a variety of evolving interface problems, including verification of von Neumann-Mullins' law in two dimensions (and its analog in three dimensions), as well as normal driven flow and curvature flow with and without constraints, demonstrating topological change and the effects of different boundary conditions. We couple the method to a second order projection method solver for incompressible fluid flow, and study the effects of membrane permeability and impermeability, large shearing torsional forces, and the effects of varying density, viscosity and surface tension on a per-phase basis. Finally, we demonstrate convergence in both space and time of a topological change in a multiphase foam. © 2012 Elsevier Inc.