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Objectives To describe the presentation and outcome of SARS-CoV2 infection in an African setting of high non-communicable co-morbidity and also HIV-1 and tuberculosis prevalence. Design Case control analysis with cases stratified by HIV-1 and tuberculosis status. Setting A single-centre observational case-control study of adults admitted to a South African hospital with proven SARS-CoV-2 infection or alternative diagnosis. Participants 104 adults with RT-PCR-proven SARS-CoV2 infection of which 55 (52.9%) were male and 31 (29.8%) HIV-1 co-infected. 40 adults (35.7% male, 30.9% HIV-1 co-infected) admitted during the same period with no RT-PCR or serological evidence of SARS-CoV2 infection and assigned alternative diagnoses. Additional in vitro data from prior studies of 72 healthy controls and 118 HIV-1 uninfected and infected persons participants enrolled to a prior study with either immune evidence of tuberculosis sensitization but no symptoms or microbiologically confirmed pulmonary tuberculosis. Results Two or more co-morbidities were present in 57.7% of 104 RT-PCR proven COVID-19 presentations, the commonest being hypertension (48%), type 2 diabetes mellitus (39%), obesity (31%) but also HIV-1 (30%) and active tuberculosis (14%). Amongst patients dually infected by tuberculosis and SARS-CoV-2, clinical features could be dominated by either SARS-CoV-2 or tuberculosis: lymphopenia was exacerbated, and some markers of inflammation (D-dimer and ferritin) elevated in singly SARS-CoV-2 infected patients were even further elevated (p < 0.05). HIV-1 and SARS-CoV2 co-infection resulted in lower absolute number and proportion of CD4 lymphocytes, with those in the lowest peripheral CD4 percentage strata exhibiting absent or lower antibody responses against SARS-CoV2. Death occurred in 30/104 (29%) of all COVID-19 patients and in 6/15 (40%) of patients with coincident SARS-CoV-2 and tuberculosis. Conclusions In this South African setting, HIV-1 and tuberculosis are common co-morbidities in patients presenting with COVID-19. In environments in which tuberculosis is common, SARS-CoV-2 and tuberculosis may co-exist with clinical presentation being typical of either disease. Clinical suspicion of exacerbation of co-existent tuberculosis accompanying SARS-CoV-2 should be high. What is already known on this topic?It has been quite widely thought that Africa has been spared the worst effects of the COVID-19 pandemic. There are very few reported case series and no case-control studies comparing COVID-19 patients admitted to hospital to those admitted for other reasons. However several studies have indicated both HIV-1 and tuberculosis co-infection that are endemic in Africa constitute risk factors for poor outcome. In addition Africa is subject to demographic transition and the prevalence of non-communicable co-morbidities such as type 2 diabetes, hypertension and cardiovascular disease is rising rapidly. No study from Africa has described the clinical impact on the presentation of COVID-19 infection. What this study adds Two or more co-morbidities were present in over half COVID-19 presentations, including HIV-1 (30%) and active tuberculosis (14%). Patients dually infected by tuberculosis and SARS-CoV-2, presented as either SARS-CoV-2 or tuberculosis. HIV-1 and SARS-CoV2 co-infection resulted in lower absolute number and proportion of CD4 lymphocytes, and those with low CD4 counts had absent or lower antibody responses against SARS-CoV2. Death occurred 29% of all COVID-19 patients and in 40% of patients with coincident SARS-CoV-2 and tuberculosis. Thus in environments in which tuberculosis is common, SARS-CoV-2 and tuberculosis may co-exist with clinical presentation being typical of either disease and clinical suspicion of exacerbation of co-existent tuberculosis accompanying SARS-CoV-2 should be high. Competing Interest Statement The authors have declared no competing interest. Funding Statement This research was funded in whole, or in part, by Wellcome [104803, 203135, 222754]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. RJW was supported by the Francis Crick Institute which receives its core funding from Cancer Research UK (FC0010218), the UK Medical Research Council (FC0010218), and Wellcome (FC0010218).

The fast-changing digital media environment has provoked new communication processes in contemporary society. In particular, younger generations engage in new ways of interacting with each other thanks to the constant emergence of digital technologies and mobile communication outlets. New habits arise every year, changing not only our interpersonal communication, but also our overall consumption of information and entertainment content, with video and instant messaging apps being particularly popular among younger populations. This study employs a mixed method approach to measure young Hispanics’ motivations to use smartphones in Chile, Mexico and the U.S. The subjects, 18 to 25 years old, participated in focus groups and surveys conducted in 2015: 55 Hispanic smartphone users joined focus groups whilst 1,403 respondents completed surveys in Chile, Mexico and Texas (U.S.). Results show similarities and differences in young Hispanics’ motivations and uses of smartphones, including the personal and commercial value they ascribe to information, time spent on social networks, and their preferences for mobile devices compared to other media. The findings are used to develop three archetypes of young users, based on smartphone’s motivations and uses. Utilizing factor analysis scores, a linear regression analysis was conducted to identify the main traits of these three archetypes: “always connected,” “entertained,” and “secure.”

Cerium oxide nanoparticles (nCeO) are currently used in many sectors of our economy, for instance as fuel additives and in ceramics for catalytic converters. As a result, there are concerns about their release and resulting toxicity in the aquatic environment. The purpose of this study was to examine the bioavailability and toxicity of nCeO and Ce(IV) in zebra mussels (Dreissena polymorpha) in various types of surface water differing in organic matter, conductivity and pH. Mussels were exposed to 100 μg/L Ce as either nCeO or Ce(IV) for 96 h in 4 types of water: 1) green water (high conductivity and low total organic carbon), 2) brown water (low conductivity and high natural total organic matter), 3) 10% municipal effluent (high conductivity and high anthropogenic organic matter) and 4) controls, which consisted of dechlorinated tap water. After the exposure period, the mussels were analyzed for morphological changes, resistance to survive in air, triglycerides (fat reserves), oxidative stress (arachidonate cyclooxygenase and lipid peroxidation) and DNA damage. Evidence of aggregation was observed with nCeO in most types of water, with the exception of the diluted municipal effluent. The data revealed that some of the effects of nCeO were influenced by surface water properties. The mussels were more sensitive to air emersion when exposed to nCeO in green water but not in the other water types and Ce(IV) to all types of water, although a marginal decrease was observed in mussels co-exposed to the diluted municipal effluent. A general decrease in oxidative stress and lipid levels was observed with both forms of Ce and all water types. Ce(IV) in brown water did not reduce the levels of DNA strand breaks compared with the controls. In conclusion, the sublethal toxicity of nCeO could be modulated by the surface water from which the nanoparticle is suspended., Invertebrate Survival Journal, Vol 16 No 1 (2019)