title: Spotlight on avian coronaviruses

text: Coronaviruses (CoVs) mainly cause enteric and/or respiratory signs. Mammalian CoVs including COVID-19 (now officially named SARS-CoV-2) belong to either the Alphacoronavirus or Betacoronavirus genera. In birds, the majority of the known CoVs belong to the Gammacoronavirus genus, whilst a small number are classified as Deltacoronaviruses. Gammacoronaviruses continue to be reported in an increasing number of avian species, generally by detection of viral RNA. Apart from infectious bronchitis virus in chickens, the only avian species in which CoV has been definitively associated with disease are the turkey, pheasant and guinea fowl. Whilst there is strong evidence for recombination between gammacoronaviruses of different avian species, and between betacoronaviruses in different mammals, evidence of recombination between coronaviruses of different genera is lacking. Furthermore, the recombination of an alpha or betacoronavirus with a gammacoronavirus is extremely unlikely. For recombination to happen, the two viruses would need to be present in the same cell of the same animal at the same time, a highly unlikely scenario as they cannot replicate in the same host!


Universal Testing-Based Response to COVID-19 Outbreak by a Long-Term Care and Post-Acute Care Facility


World leaders in covid-19 control


docid: zwevcojh

title: The Impact of Covid-19 on Mental Health: the Interactive Roles of Brain Biotypes and Human Connection

text: COVID-19 along with the mitigation strategies being used to address the virus pose significant threats to our individual and collective mental health. As the crisis evolves and persists, it will be increasingly important for the research community to conduct investigations that address the mental health consequences of COVID-19. The causes of mental health effects in the context of COVID-19 are multifactorial and likely include biological, behavioral, and environmental determinants. We argue that the COVID-19 crisis significantly threatens our basic human need for human connection, which might serve as a crucial environmental factor that could underlie the overall insult to our mental health. Furthermore, "brain styles," which we have previously conceptualized as "biotypes" that are informed by a neural taxonomy, might interact with the universal threat to our need for human connection to explain the mental health consequences of COVID-19 from a precision psychiatry perspective. The goal of this commentary is to inspire research on the mental health consequences of COVID-19 from an individualized, brain-based perspective that honors the profound threat that the virus poses to our basic human motivations.


Silent casualty of COVID-19: Training and education


title: As We Went to Press: The United States Responds to COVID-19

text: Ventilators, masks, and tests are in short supply.


SARS-CoV-2 Induces Acute and Refractory Relapse of Systemic Capillary Leak Syndrome (Clarkson's Disease)


title: What the reproductive number R_0 can and cannot tell us about COVID-19 dynamics

text: The reproductive number R_0 (and its value after initial disease emergence R) has long been used to predict the likelihood of pathogen invasion, to gauge the potential severity of an epidemic, and to set policy around interventions. However, often ignored complexities have generated confusion around use of the metric. This is particularly apparent with the emergent pandemic virus SARS-CoV-2, the causative agent of COVID-19. We address some of these misconceptions, namely, how R changes over time, varies over space, and relates to epidemic size by referencing the mathematical definition of R and examples from the current pandemic. We hope that a better appreciation of the uses, nuances, and limitations of R facilitates a better understanding of epidemic spread, epidemic severity, and the effects of interventions in the context of SARS-CoV-2.


European universities dismal at reporting results of clinical trials


Het betrekken van de ouders bij de hulp aan suïcidale jongeren is een must./ [Involving the parents in the care for suicidal youth is a must]


Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy


title: Gastroscopic surveillance with targeted biopsies compared with random biopsies in CDH1 mutation carriers

text: BACKGROUND : The International Gastric Cancer Linkage Consortium (IGCLC) consensus guideline advises prophylactic gastrectomy in early adulthood to prevent gastric cancer development in CDH1 germline mutation carriers; psychosocial reasons may postpone gastrectomy. We analyzed the yield of signet-ring cell carcinoma (SRCC) during surveillance gastroscopy in CDH1 mutation carriers. METHODS : A retrospective analysis on surveillance gastroscopies in CDH1 mutation carriers was performed. The yield of SRCC in both targeted and random biopsies was studied. Endoscopic (biopsy) results were compared with the histopathologic outcomes in gastrectomy specimens. RESULTS : 42 CDH1 mutation carriers (18 men; mean age 43, range 20-82 years) underwent 96 surveillance gastroscopies. SRCC lesions were identified on surveillance gastroscopy in 21 patients (50â%), by either targeted biopsies only (nâ=â11), random biopsies only (nâ=â3), or both random and targeted biopsies (nâ=â7). SRCC was detected in 41â/377 targeted biopsies (11â%), whereas random biopsies revealed SRCC in 14/1563 biopsies (0.9â%). At least one SRCC lesion was found in 26 of 30 gastrectomy specimens. In 18 of these 26 specimens (69â%), SRCC had been identified by endoscopic biopsies. Missed lesions were all small superficial SRCC foci, mainly in the body of the stomach. CONCLUSION : In our cohort of CDH1 mutation carriers, SRCC lesions were identified by an extensive endoscopic surveillance protocol in 69â% of SRCC-positive patients who underwent a gastric resection. The low number of SRCC detected through random sampling demands a critical reappraisal of random biopsy sampling in the IGCLC guideline.


Cells edited with CRISPR prove safe in humans


title: PM&R and Pulmonary Rehabilitation for COVID-19

text: This analysis extrapolates information from prior studies and experiences to bring PM&R perspective and intervention to the multidisciplinary treatment of COVID-19. The purpose of pulmonary rehabilitation in COVID-19 patients is to improve symptoms of dyspnea, relieve anxiety, reduce complications, minimize disability, preserve function and improve quality of life. Pulmonary rehabilitation during the acute management of COVID-19 should be considered when possible and safe and may include nutrition, airway, posture, clearance technique, oxygen supplementation, breathing exercises, stretching, manual therapy, and physical activity. Given the possibility of long-term disability, outpatient post-hospitalization pulmonary rehabilitation may be considered in all patients hospitalized with COVID-19.


Calling all coronavirus researchers: keep sharing, stay open


title: GeoCoV19: A Dataset of Hundreds of Millions of Multilingual COVID-19 Tweets with Location Information

text: The past several years have witnessed a huge surge in the use of social media platforms during mass convergence events such as health emergencies, natural or human-induced disasters. These non-traditional data sources are becoming vital for disease forecasts and surveillance when preparing for epidemic and pandemic outbreaks. In this paper, we present GeoCoV19, a large-scale Twitter dataset containing more than 524 million multilingual tweets posted over a period of 90 days since February 1, 2020. Moreover, we employ a gazetteer-based approach to infer the geolocation of tweets. We postulate that this large-scale, multilingual, geolocated social media data can empower the research communities to evaluate how societies are collectively coping with this unprecedented global crisis as well as to develop computational methods to address challenges such as identifying fake news, understanding communities' knowledge gaps, building disease forecast and surveillance models, among others.


title: A call to action becomes practice: cardiac and vascular surgery during the COVID-19 pandemic based on the Lombardy emergency guidelines

text: OBJECTIVES: During the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pandemic, Northern Italy had to completely reorganize its hospital activity. In Lombardy, the hub-and-spoke system was introduced to guarantee emergency and urgent cardiovascular surgery, whereas most hospitals were dedicated to patients with coronavirus disease 2019 (COVID-19). The aim of this study was to analyse the results of the hub-and-spoke organization system. METHODS: Centro Cardiologico Monzino (Monzino) became one of the four hubs for cardiovascular surgery, with a total of eight spokes. SARS-CoV-2 screening became mandatory for all patients. New flow charts were designed to allow separated pathways based on infection status. A reorganization of spaces guaranteed COVID-19-free and COVID-19-dedicated areas. Patients were also classified into groups according to their pathological and clinical status: emergency, urgent and non-deferrable (ND). RESULTS: A total of 70 patients were referred to the Monzino hub-and-spoke network. We performed 41 operations, 28 (68.3%) of which were emergency/urgent and 13 of which were ND. The screening allowed the identification of COVID-19 (three patients, 7.3%) and non-COVID-19 patients (38 patients, 92.7%). The newly designed and shared protocols guaranteed that the cardiac patients would be divided into emergency, urgent and ND groups. The involvement of the telematic management heart team allowed constant updates and clinical discussions. CONCLUSIONS: The hub-and-spoke organization system efficiently safeguards access to heart and vascular surgical services for patients who require ND, urgent and emergency treatment. Further reorganization will be needed at the end of this pandemic when elective cases will again be scheduled, with a daily increase in the number of operations.


STEMI care during COVID-19: losing sight of the forest for the trees


Covid-19 Crisis Triage - Optimizing Health Outcomes and Disability Rights


title: Cardiovascular system and COVID-19: perspectives from a developing country

text: A novel coronavirus, SARS-CoV-2, thought to have originated from bats causes COVID-19 infection which was first reported from Wuhan, China in December 2019. This virus has a high infectivity rate and has impacted a significant chunk of the population worldwide. The spectrum of disease ranges from mild to severe with respiratory system being the most commonly affected. Cardiovascular system often gets involved in later stages of the disease with acute cardiac injury, heart failure and arrhythmias being the common complications. In addition, the presence of cardiovascular co-morbidities such as hypertension, coronary artery disease in these patients are often associated with poor prognosis. It is still not clear regarding the exact mechanism explaining cardiovascular system involvement in COVID-19. Multiple theories have been put forward however, more robust studies are required to fully elucidate the "heart and virus" link. The disease has already made its presence felt on the global stage and its impact in the developing countries is going to be profound. These nations not only have a poorly developed healthcare system but there is also a huge burden of cardiovascular diseases. As a result, COVID-19 would adversely impact the already overburdened healthcare network leading to impaired cardiovascular care delivery especially for acute coronary syndrome and heart failure patients.


Pneumomediastinum Related to Covid-19 Pneumonia


title: Maternal and neonatal outcomes associated with COVID-19 infection: A systematic review

text: BACKGROUND: COVID-19 has created an extraordinary global health crisis. However, with limited understanding of the effects of COVID-19 during pregnancy, clinicians and patients are forced to make uninformed decisions. OBJECTIVES: To systematically evaluate the literature and report the maternal and neonatal outcomes associated with COVID-19. SEARCH STRATEGY: PubMed, MEDLINE, and EMBASE were searched from November 1st, 2019 and March 28th, 2020. SELECTION CRITERIA: Primary studies, reported in English, investigating COVID-19-positive pregnant women and reporting their pregnancy and neonatal outcomes. DATA COLLECTION AND ANALYSIS: Data in relation to clinical presentation, investigation were maternal and neonatal outcomes were extracted and analysed using summary statistics. Hypothesis testing was performed to examine differences in time-to-delivery. Study quality was assessed using the ICROMS tool. MAIN RESULTS: Of 73 identified articles, nine were eligible for inclusion (n = 92). 67.4% (62/92) of women were symptomatic at presentation. RT-PCR was inferior to CT-based diagnosis in 31.7% (26/79) of cases. Maternal mortality rate was 0% and only one patient required intensive care and ventilation. 63.8% (30/47) had preterm births, 61.1% (11/18) fetal distress and 80% (40/50) a Caesarean section. 76.92% (11/13) of neonates required NICU admission and 42.8% (40/50) had a low birth weight. There was one indeterminate case of potential vertical transmission. Mean time-to-delivery was 4.3±3.08 days (n = 12) with no difference in outcomes (p>0.05). CONCLUSIONS: COVID-19-positive pregnant women present with fewer symptoms than the general population and may be RT-PCR negative despite having signs of viral pneumonia. The incidence of preterm births, low birth weight, C-section, NICU admission appear higher than the general population.


title: Biochanin-A elicits relaxation in coronary artery of goat through different mechanisms

text: Flavonoids have shown beneficial effects in various disease conditions as reported by various previous studies. Biochanin-A is a flavonoid present in various plants in nature. Present investigation was done to assess the vasorelaxant potential of biochanin-A on isolated coronary artery of goat and its possible mechanism of action. Vascular reactivity experiments were done on circumflex coronary artery of goats using the tension experiments. Goat coronary arterial rings were relaxed with biochanin-A in concentration (0.1-100 µM)-dependent manner. Endothelium had no effect on biochanin-A-induced relaxation. Maximum relaxation induced by biochanin-A was 116.54 ± 12.21% in endothelium-intact artery and it was not significantly different with maximal relaxation (108.22 ± 1.88%) of endothelium-denuded vessel. L-NAME (100 µM) did not show any effect on biochanin-A-induced relaxation. TEA (BKCa channel blocker), and BaCl2 (KIR blocker) had no effect on biochanin-A-induced relaxation. However, biochanin-A-induced maximal relaxation (71.72 ± 4.50%) was reduced significantly (P < .001) in the presence of 4-aminopyridine (KV channel blocker, 3 mM) in comparison with control (114.07 ± 4.33%). Glibenclaminde (KATP channel blocker), H89 (PKA inhibitor), ICI182780 (estrogen receptor antagonist) showed partial attenuation in the biochanin-A-induced relaxation. ODQ (sGC blocker) and HC067047 (TRPV4 channel blocker) had no effect on biochanin-A-induced relaxation. In K+-depolarized endothelium-denuded arterial rings, biochanin-A (30 µM) significantly (P < .05; P < .001) decreased CaCl2-induced contractions (0.02 ± 0.01 g vs. control 0.73 ± 0.30 g). Biochanin-A did not influence the fasudil (rho kinase inhibitor) and SNP (NO-donor)-induced relaxation in this vessel. Biochanin-A showed relaxation in goat coronary artery in endothelium-independent pathways and showed the partial involvement of KATP, protein kinase A and estrogen receptors and full involvement of Cav1.2 channels.


title: Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China

text: Importance: Coronavirus disease 2019 (COVID-19) has resulted in considerable morbidity and mortality worldwide since December 2019. However, information on cardiac injury in patients affected by COVID-19 is limited. Objective: To explore the association between cardiac injury and mortality in patients with COVID-19. Design, Setting, and Participants: This cohort study was conducted from January 20, 2020, to February 10, 2020, in a single center at Renmin Hospital of Wuhan University, Wuhan, China; the final date of follow-up was February 15, 2020. All consecutive inpatients with laboratory-confirmed COVID-19 were included in this study. Main Outcomes and Measures: Clinical laboratory, radiological, and treatment data were collected and analyzed. Outcomes of patients with and without cardiac injury were compared. The association between cardiac injury and mortality was analyzed. Results: A total of 416 hospitalized patients with COVID-19 were included in the final analysis; the median age was 64 years (range, 21-95 years), and 211 (50.7%) were female. Common symptoms included fever (334 patients [80.3%]), cough (144 [34.6%]), and shortness of breath (117 [28.1%]). A total of 82 patients (19.7%) had cardiac injury, and compared with patients without cardiac injury, these patients were older (median [range] age, 74 [34-95] vs 60 [21-90] years; P < .001); had more comorbidities (eg, hypertension in 49 of 82 [59.8%] vs 78 of 334 [23.4%]; P < .001); had higher leukocyte counts (median [interquartile range (IQR)], 9400 [6900-13â¯800] vs 5500 [4200-7400] cells/µL) and levels of C-reactive protein (median [IQR], 10.2 [6.4-17.0] vs 3.7 [1.0-7.3] mg/dL), procalcitonin (median [IQR], 0.27 [0.10-1.22] vs 0.06 [0.03-0.10] ng/mL), creatinine kinase-myocardial band (median [IQR], 3.2 [1.8-6.2] vs 0.9 [0.6-1.3] ng/mL), myohemoglobin (median [IQR], 128 [68-305] vs 39 [27-65] µg/L), high-sensitivity troponin I (median [IQR], 0.19 [0.08-1.12] vs <0.006 [<0.006-0.009] µg/L), N-terminal pro-B-type natriuretic peptide (median [IQR], 1689 [698-3327] vs 139 [51-335] pg/mL), aspartate aminotransferase (median [IQR], 40 [27-60] vs 29 [21-40] U/L), and creatinine (median [IQR], 1.15 [0.72-1.92] vs 0.64 [0.54-0.78] mg/dL); and had a higher proportion of multiple mottling and ground-glass opacity in radiographic findings (53 of 82 patients [64.6%] vs 15 of 334 patients [4.5%]). Greater proportions of patients with cardiac injury required noninvasive mechanical ventilation (38 of 82 [46.3%] vs 13 of 334 [3.9%]; P < .001) or invasive mechanical ventilation (18 of 82 [22.0%] vs 14 of 334 [4.2%]; P < .001) than those without cardiac injury. Complications were more common in patients with cardiac injury than those without cardiac injury and included acute respiratory distress syndrome (48 of 82 [58.5%] vs 49 of 334 [14.7%]; P < .001), acute kidney injury (7 of 82 [8.5%] vs 1 of 334 [0.3%]; P < .001), electrolyte disturbances (13 of 82 [15.9%] vs 17 of 334 [5.1%]; P = .003), hypoproteinemia (11 of 82 [13.4%] vs 16 of 334 [4.8%]; P = .01), and coagulation disorders (6 of 82 [7.3%] vs 6 of 334 [1.8%]; P = .02). Patients with cardiac injury had higher mortality than those without cardiac injury (42 of 82 [51.2%] vs 15 of 334 [4.5%]; P < .001). In a Cox regression model, patients with vs those without cardiac injury were at a higher risk of death, both during the time from symptom onset (hazard ratio, 4.26 [95% CI, 1.92-9.49]) and from admission to end point (hazard ratio, 3.41 [95% CI, 1.62-7.16]). Conclusions and Relevance: Cardiac injury is a common condition among hospitalized patients with COVID-19 in Wuhan, China, and it is associated with higher risk of in-hospital mortality.


title: An Observational Cohort Study of Hydroxychloroquine and Azithromycin for COVID-19: (Can't Get No) Satisfaction

text: It can be said that SARS-CoV-2 caught the world by surprise. In large part due to globalization, the virus quickly evolved from a serious regional concern to a worldwide pandemic, the likes of which are unprecedented in the last century. In a matter of weeks, COVID-19 became a leading cause of death, with a potential staggering death toll in 2020. Due to a heavy burden of illness, and in the absence of proven therapies, several experimental treatments have been and continue to be prescribed outside of clinical trial settings. Of the potential therapeutic options that showed early promise, few have generated as much controversy, or been subject to such politicization, as hydroxychloroquine. In this issue of the International Journal of Infectious Diseases, Arshad et. al have added more fuel to the fire.


title: Community Calls: Lessons and Insights Gained from a Medical-Religious Community Engagement During the COVID-19 Pandemic

text: During the pandemic caused by the severe acute respiratory syndrome coronavirus-2, public health instructions were issued with the hope of curbing the virus' spread. In an effort to assure accordance with these instructions, equitable strategies for at-risk and vulnerable populations and communities are warranted. One such strategy was our community conference calls, implemented to disseminate information on the pandemic and allow community leaders to discuss struggles and successes. Over the first 6 weeks, we held 12 calls, averaging 125 (standard deviation 41) participants. Participants were primarily from congregations and faith-based organizations that had an established relationship with the hospital, but also included school leaders, elected officials, and representatives of housing associations. Issues discussed included reasons for quarantining, mental health, social isolation, health disparities, and ethical concerns regarding hospital resources. Concerns identified by the community leaders as barriers to effective quarantining and adherence to precautions included food access, housing density, and access to screening and testing. Through the calls, ways to solve such challenges were addressed, with novel strategies and resources reaching the community. This medical-religious resource has proven feasible and valuable during the pandemic and warrants discussions on reproducing it for other communities during this and future infectious disease outbreaks.


title: Simple nomogram based on initial laboratory data for predicting the probability of ICU transfer of COVID-19 patients: Multicenter retrospective study

text: This retrospective, multicenter study investigated risk factors associated with intensive care unit (ICU) admission and transfer in 461 adult patients with confirmed coronavirus disease 2019 (COVID-19) hospitalized from January 22 to March 14, 2020 in Hunan Province, China. Outcomes of ICU and non-ICU patients were compared, and a simple nomogram for predicting the probability of ICU transfer after hospital admission was developed based on initial laboratory data using a Cox proportional hazards regression model. Differences in laboratory indices were observed between patients admitted to the ICU and those who were not admitted. Several independent predictors of ICU transfer in COVID-19 patients were identified including older age (≥65 years) (hazard ratio [HR]=4.02), hypertension (HR=2.65), neutrophil count (HR=1.11), procalcitonin level (HR=3.67), prothrombin time (HR=1.28), and d-dimer level (HR=1.25). Lymphocyte count and albumin level were negatively associated with mortality (HR=0.08 and 0.86, respectively). The developed model provides a means for identifying, at hospital admission, the subset of patients with COVID-19 who are at high risk of progression and would require transfer to the ICU within 3 and 7 days after hospitalization. This method of early patient triage allows more effective allocation of limited medical resources. This article is protected by copyright. All rights reserved.


title: Elucidation of Cellular Targets and Exploitation of the Receptor Binding Domain of SARS-CoV-2 for vaccine and monoclonal antibody synthesis

text: The pandemic caused by novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has resulted in over 452,822 deaths in the first twenty days of June 2020 due to the coronavirus virus disease 2019 (COVID-19). The SARS-CoV-2 uses the host angiotensin-converting enzyme 2 (ACE2) receptor to gain entry inside the human cells where it replicates by using the cell protein synthesis mechanisms. The knowledge of the tissue distribution of ACE2 in human organs is therefore important to predict the clinical course of the COVID-19. Also important is the understanding of the viral receptor-binding domain (RBD) a region within the spike (S) proteins that enable the entry of the virus into the host cells to synthesize vaccine and monoclonal antibodies (mAbs). We performed an exhaustive search of human protein databases to establish the tissues that express ACE2 and performed an in-depth analysis like sequence alignments and homology modeling of the spike protein (S) of the SARS-CoV-2 to identify antigenic regions in the RBD that can be exploited to synthesize vaccine and mAbs. Our results show that ACE2 is widely expressed in human organs that may explain the pulmonary, systemic, and neurological deficits seen in COVID-19 patients. We show that though the S protein of the SARS-CoV-2 is a homolog of S protein of SARS-CoV-1, it has regions of dissimilarities in the RBD and transmembrane segments. We show peptide sequences in the RBD of SARS-CoV-2 that can bind to the MHC alleles and serve as effective epitopes for vaccine and mAbs synthesis. This article is protected by copyright. All rights reserved.


title: Anticoagulant and antiarrhythmic effects of heparin in the treatment of COVID-19 patients

text: Most severe manifestations of COVID-19 cases, such as multiple organ failure and death, have been linked to coagulation dysfunction markers, such as platelet reduction and increases in prothrombin time, fibrin degradation products and, mainly, D-dimer [1]. A recent paper by Tang et al. [2] in this journal reported that heparin treatment reduced mortality of COVID-19 patients with elevated D-dimer; similar preliminary results have been reported elsewhere [3]. A mounting body of evidence shows that SARS-CoV-2 causes a "cytokine storm" [1,4] that activates the coagulation cascade, leading to thrombosis. Similar to the findings in severe sepsis, generalized deposition of intravascular thrombi compromises the blood supply of several organs, leading to organ failure [5].


Guidance on the management of Diabetic Ketoacidosis in the exceptional circumstances of the COVID-19 pandemic


title: Healthcare information on YouTube: Pregnancy and COVID-19

text: OBJECTIVE: We aimed to analyze Turkish language videos on YouTube about Coronavirus and pregnancy. METHODS: YouTube was searched for the following keywords: "Coronavirus, gebelik," "Coronavirus, Hamilelik," "COVID-19, gebelik" and "COVID-19, hamilelik". All ranking data for each video was recorded, video sources and target audiences were analyzed. Videos were designated as "informative, "misleading" "personal experience" and "news update." The usefulness of the videos were analyzed by DISCERN score and the quality of the content was calculated by MICI score. RESULTS: Seventy-six videos had a total of 1.494.860 views, with 40.849 likes and 575 dislikes. The source of information in informative videos was physicians (73%), and news agencies (20%), and the majority of these targeted patients. The DISCERN score of videos was 2.9 ± 1, 1.6 ± 0.9, and 1.9 ± 0.9 respectively for respectively for the informative group, personal experience group, and news update group. The mean MICI score for informative videos was low and calculated as 5.3 ± 2.8. CONCLUSION: YouTube videos are easily accessible sources of COVID-19 information for pregnant women. The present study demonstrated that videos about pregnancy and COVID-19 have high view rates, but are generally low in quality and trustworthiness.


title: Clinical characteristics of asymptomatic and symptomatic patients with mild COVID-19

text: OBJECTIVES: Detailed knowledge on the prevalence of asymptomatic cases of coronavirus disease 2019 (COVID-19) and the clinical characteristics of mild COVID-19 is essential for effective control of the COVID-19 pandemic. We determined the prevalence of asymptomatic cases of COVID-19 and characterized the symptoms of patients with mild COVID-19. METHODS: Study participants were recruited from a community facility designated for the isolation of patients without moderate-to-severe symptoms of COVID-19 in South Korea. The prevalence of asymptomatic patients at admission and the detailed symptoms of mild COVID-19 were evaluated through a questionnaire-based survey. Diagnosis of COVID-19 was confirmed by real-time RT-PCR. RESULTS: Of the 213 individuals with COVID-19, 41 (19.2%) were asymptomatic until admission. Among the remaining patients with mild COVID-19, the most common symptom was cough (40.1%; 69/172), followed by hyposmia (39.5%; 68/172) and sputum (39.5%; 68/172). Of the 68 individuals with hyposmia, 61 (90%) had accompanying symptoms such as hypogeusia, nasal congestion or rhinorrhoea. Fever (>37.5°C) was only observed in 20 (11.6%) individuals. CONCLUSIONS: As much as one-fifth of individuals with COVID-19 remained asymptomatic from exposure to admission. Hyposmia was quite frequent among individuals with mild COVID-19, but fever was not. Social distancing should be strongly implemented to prevent disease transmission from asymptomatic individuals or those with mild and inconspicuous symptoms.


title: Prophylactic (hydroxy)chloroquine in COVID-19: potential relevance for cardiac arrhythmia risk

text: (Hydroxy)chloroquine ((H)CQ) is being investigated as treatment for COVID-19, but studies have so far demonstrated either no or a small benefit. However, these studies have been mostly performed in patients admitted to hospital and hence likely already (severely) affected. Another suggested approach employs prophylactic (H)CQ treatment aimed at preventing either SARS-CoV-2 infection or development of disease. A substantial number of clinical trials are planned or underway aimed at assessing the prophylactic benefit of (H)CQ. However, (H)CQ may lead to QT-prolongation and potentially induce life-threatening arrhythmias. This may be of particular relevance for patients with pre-existing cardiovascular disease and those taking other QT-prolonging drugs. In addition, it is known that a certain percentage of the population carries genetic variant(s) which reduces their repolarization reserve, predisposing them to (H)CQ-induced QT-prolongation, and this may be more relevant in females who already have a longer QT to start with. This review provides an overview of the current evidence on (H)CQ therapy in COVID-19 patients and discusses different strategies for prophylactic (H)CQ therapy (i.e. pre-infection, post-exposure, post-infection). In particular, the potential cardiac effects, including QT-prolongation and arrhythmias will be addressed. Based on these insights, recommendations will be presented as to which preventive measures should be taken when giving (H)CQ prophylactically, including ECG monitoring.


e-Health vs COVID-19: home patient telemonitoring to maintain TIA continuum of care


Treatment of Community-Acquired Pneumonia During the Coronavirus Disease 2019 (COVID-19) Pandemic


title: Social support and mental health among health care workers during Coronavirus Disease 2019 outbreak: A moderated mediation model

text: PURPOSES: During the outbreak of Coronavirus Disease 2019 (COVID-19) all over the world, the mental health conditions of health care workers are of great importance to ensure the efficiency of rescue operations. The current study examined the effect of social support on mental health of health care workers and its underlying mechanisms regarding the mediating role of resilience and moderating role of age during the epidemic. METHODS: Social Support Rating Scale (SSRS), Connor-Davidson Resilience scale (CD-RISC) and Symptom Checklist 90 (SCL-90) were administrated among 1472 health care workers from Jiangsu Province, China during the peak period of COVID-19 outbreak. Structural equation modeling (SEM) was used to examine the mediation effect of resilience on the relation between social support and mental health, whereas moderated mediation analysis was performed by Hayes PROCESS macro. RESULTS: The findings showed that resilience could partially mediate the effect of social support on mental health among health care workers. Age group moderated the indirect relationship between social support and mental health via resilience. Specifically, compared with younger health care workers, the association between resilience and mental health would be attenuated in the middle-aged workers. CONCLUSIONS: The results add knowledge to previous literature by uncovering the underlying mechanisms between social support and mental health. The present study has profound implications for mental health services for health care workers during the peak period of COVID-19.


COVID-19, Telemedicine, and Patient Empowerment in HIV Care and Research


title: Can graphene take part in the fight against COVID-19?

text: The pneumonia outbreak of coronavirus disease 2019 (COVID-19) represents a global issue. The bidimensional material graphene has captured much attention due to promising antimicrobial applications and has also demonstrated antiviral efficacy. In response to this global outbreak, we summarized the current state of knowledge of graphene and virus interaction as well as possible successful applications to fight COVID-19. Antibody-conjugated graphene sheets can rapidly detect targeted virus proteins and can be useful for large population screening, but also for the development of environmental sensors and filters, given the low cost of graphene materials. The functionalized graphene has demonstrated a good viral capture capacity that, combined with heat or light-mediated inactivation, could be used as a disinfectant. Graphene sensors arrays can be implemented on standard utility textiles and drug efficacy screening. Thanks to its high versatility, we foresee that graphene may have a leading role in the fight against COVID-19.


Global crisis: EM and EMJ respond


docid: yjonlzde

title: Feasibility of coronavirus disease 2019 eradication


Rechtliche Betreuung in Zeiten der COVID-19 Pandemie


Asymptomatic COVID-19 transmission: the importance of avoiding official miscommunication


title: COVID-19 and SARS-Cov-2 Infection: Pathophysiology and Clinical Effects on the Nervous System

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-Cov-2, resulting in severe acute respiratory syndrome, with high potential of spreading and infecting humans worldwide. Since December 2019, when the virus was identified in humans, the literature on COVID-19 has grown exponentially and extrarespiratory symptoms including neurologic symptoms are increasingly highlighted. METHODS: Given the high and increasing number of publications reporting neurologic involvements of SARS-Cov-2, we thought that providing an update for neurologic complications of COVID-19 would be useful for physicians and especially young trainees in neurology and neurosurgery. Indeed, in this review we discuss several neurologic aspects reported in the literature to date including the evidence and pathways of neuroinvasion in COVID-19 and the main neurologic disorders reported in the literature to date, as well as future perspectives and the potential long-term consequence of current neuroinfection in COVID-19 patients. RESULTS: Currently, there is convincing evidence that SARS-CoV-2, the etiologic agent of COVID-19, can affect the nervous system, with damage and neurologic alterations. These neurologic disorders are grouped into several categories, ranging from nonspecific and moderate symptoms such as headache, myalgia, and hyposmia to severe symptoms including cerebrovascular disease and intracranial infections. Severe neurologic symptoms such as acute cerebrovascular disease occur only in a minority of patients with usual risk factors and are associated with poor outcome. However, most COVID-19 patients exhibit only minor or mild neurologic symptoms. CONCLUSIONS: Management of COVID-19 patients should include early clinical, radiologic, and laboratory neurologic assessment, with a close follow-up, especially in severe forms. Future studies should assess late and long-term consequences of current COVID-19 patients with neurologic involvement.


Implementation and Impact of Universal Pre-procedure Testing of Patients for COVID-19 prior to Endoscopy


Molecular pharmacology of ciclesonide against SARS-CoV-2


title: How long does a lockdown need to be?

text: Social distancing, often in the form of lockdown, has been adopted by many countries as a way to contrast the spreading of COVID-19. We discuss the temporal aspects of social distancing in contrasting an epidemic diffusion. We argue that a strategy based uniquely on social distancing requires to maintain the relative measures for a very long time, while a more articulate strategy, which also uses early detection and prompt isolation, can be both more efficient on reducing the epidemic peak and allow to relax the social distancing measures after a much shorter time. We consider in more detail the situation in Italy, simulating the effect of different strategies through a recently introduced SIR-type epidemiological model. The short answer to the question in the title is:"it depends on what else you do".


title: Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

text: BACKGROUND: Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. METHODS: In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. FINDINGS: 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03-1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p<0·0001), and d-dimer greater than 1 µg/mL (18·42, 2·64-128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. INTERPRETATION: The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 µg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. FUNDING: Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.


Post-infectious Guillain-Barré syndrome related to SARS-CoV-2 infection: a case report


title: Masks and COVID-19: a causal framework for imputing value to public-health interventions

text: During the COVID-19 pandemic, the scientific community developed predictive models to evaluate potential governmental interventions. However, the analysis of the effects these interventions had is less advanced. Here, we propose a data-driven framework to assess these effects retrospectively. We use a regularized regression to find a parsimonious model that fits the data with the least changes in the Rt parameter. Then, we postulate each jump in Rt as the effect of an intervention. Following the do-operator prescriptions, we simulate the counterfactual case by forcing Rt to stay at the pre-jump value. We then attribute a value to the intervention from the difference between true evolution and simulated counterfactual. We show that the recommendation to use facemasks for all activities would reduce the number of cases by 170000 (95% CI 160000 to 180000) in Connecticut, Massachusetts, and New York State. The framework presented here might be used in any case where cause and effects are sparse in time.


title: Eating disorders during the COVID-19 pandemic and quarantine: an overview of risks and recommendations for treatment and early intervention

text: Individuals with eating disorders (EDs) are at significant risk for increases in symptomatology and diminished treatment access during the COVID-19 pandemic. Environmental precautions to limit coronavirus spread have affected food availability and access to healthy coping mechanisms, and have contributed to weight-stigmatizing social media messages that may be uniquely harmful to those experiencing EDs. Additionally, changes in socialization and routine, stress, and experiences of trauma that are being experienced globally may be particularly deleterious to ED risk and recovery. This paper presents a brief review of the pertinent literature related to the risk of EDs in the context of COVID-19 and offers suggestions for modifying intervention efforts to accommodate the unique challenges individuals with EDs and providers may be experiencing in light of the ongoing public health crisis.


Letter: Transmission of COVID-19 During Neurosurgical Procedures-Some Thoughts From the United Kingdom


title: Kommerell diverticulum - egy ritka betegség ritka szövodményei

text: Incidence of anomalies of the aortic arch is estimated 1-2 per cent in newborn babies. Lusory artery may arise either from left sided aortic arch in 0.7-2 per cent, or from right sided aortic arch in 0.4 per cent. Leading symptoms develop from compression of the oesophagus or trachea, or both. If lusory artery dilates conically over the time reaching 3 cm or more we call it Kommerell diverticulum. Very rare complications of this are the Type B aortic dissection, which may turn into chronic thoracoabdominal aneurysm, or its shaggy inner surface can be the source of upper extremity embolism. Rupture is extremely rare complication. In our report we focus on five cases of the mentioned complications with their clinical workups and technical solutions. In a female patient with right sided arch transection of the lusory artery was followed by transposition into the right common carotid artery. The central stump 10 years later gradually expanded and the saccular aneurysm indicated intervention. After complete arch debranching thoracic endograft was implanted. In this group of patients with variable surgical and hybrid procedures neither complication nor mortality occurred.


COVID 19-An eye on the virus


title: Patients with Cancer Appear More Vulnerable to SARS-CoV-2: A Multicenter Study during the COVID-19 Outbreak

text: The novel COVID-19 outbreak has affected more than 200 countries and territories as of March 2020. Given that patients with cancer are generally more vulnerable to infections, systematic analysis of diverse cohorts of patients with cancer affected by COVID-19 is needed. We performed a multicenter study including 105 patients with cancer and 536 age-matched noncancer patients confirmed with COVID-19. Our results showed COVID-19 patients with cancer had higher risks in all severe outcomes. Patients with hematologic cancer, lung cancer, or with metastatic cancer (stage IV) had the highest frequency of severe events. Patients with nonmetastatic cancer experienced similar frequencies of severe conditions to those observed in patients without cancer. Patients who received surgery had higher risks of having severe events, whereas patients who underwent only radiotherapy did not demonstrate significant differences in severe events when compared with patients without cancer. These findings indicate that patients with cancer appear more vulnerable to SARS-CoV-2 outbreak. SIGNIFICANCE: Because this is the first large cohort study on this topic, our report will provide much-needed information that will benefit patients with cancer globally. As such, we believe it is extremely important that our study be disseminated widely to alert clinicians and patients.This article is highlighted in the In This Issue feature, p. 747.


title: COVID-19 containment: China provides important lessons for global response

text: The world must act fast to contain wider international spread of the epidemic of COVID-19 now. The unprecedented public health efforts in China have contained the spread of this new virus. Measures taken in China are currently proven to reduce human-to-human transmission successfully. We summarized the effective intervention and prevention measures in the fields of public health response, clinical management, and research development in China, which may provide vital lessons for the global response. It is really important to take collaborative actions now to save more lives from the pandemic of COVID-19.


Mental health considerations for children quarantined because of COVID-19


title: Healthcare Personnel Exposure to a Patient with Asymptomatic SARS-CoV2 Infection during a Prolonged Surgical Intervention

text: There is ongoing debate regarding the role of aerosols in the transmission of SARS-CoV2 in the healthcare environment. Here we report a case in which multiple operating room healthcare providers were exposed to a patient with asymptomatic SARS-CoV2 infection during a prolonged orthopedic surgical intervention and had no evidence of COVID-19 during the 14-day post-exposure period.


title: Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans

text: BACKGROUND: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. METHODS: A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian ß-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations. RESULTS: The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90·2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72·3 per cent. Globally, 81·7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37·7 per cent of cancer operations (2 324 070 of 6 162 311) and 25·4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption. CONCLUSION: A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely.


Protection of anesthesia providers from silent carriers of COVID-19 while minimizing disposable PPE utilization


Diagnostic and digital solutions to address the COVID-19 pandemic: The need for international collaboration to close the gap


Temblor y ataxia en COVID-19./ Temblor y ataxia en COVID-19./ Tremor and ataxia in COVID-19


The COVID-19 pandemic: some lessons learned about crisis preparedness and management, and the need for international benchmarking to reduce deficits


docid: azemcqpx

title: Surgeon and Preparedness for COVID-19 Pandemic


Spiritual Lessons From the Coronavirus Pandemic


title: [Preliminary Study on Clinical Features and CT Findings of Common-type Coronavirus Disease 2019 Patients in Peking Union Medical College Hospital]

text: Objective To summarize the clinical characteristics and chest CT findings of coronavirus disease 2019(COVID-19)patients in Peking Union Medical College Hospital(PUMCH). Methods A total of 13 patients with COVID-19 confirmed at PUMCH from January 20 to February 6,2020 were selected as the research subjects.Their epidemiological histories,clinical characteristics,laboratory tests,and chest CT findings were analyzed retrospectively.The location,distribution,density,and other accompanying signs of abnormal lung CT lesions were recorded,and the clinical types of these patients were assessed. Results The clinical type was "common type" in all these 13 patients aged(46.8±14.7)years(range:27-68 years).Ten patients had a travel history to Wuhan or direct contact with patients from Wuhan,2 cases had recent travel histories,and 1 case had a travel history to Beijing suburb.The white blood cell(WBC)count was normal or decreased in 92.3% of the patients and the lymphocyte count decreased in 15.4% of the patients.Twelve patients(92.3%)had a fever,among whom 11 patients were admitted due to fever and 2 patients(15.4%)had low fever.Eight patients(61.5%)had dry cough.The CT findings in these 13 patients were all abnormal.The lesions were mainly distributed along the bronchi and under the pleura.The lesions were relatively limited in 8 patients(affecting 1-3 lobes,predominantly in the right or left lower lobe),and diffuse multiple lesions of bilateral lungs were seen in 5 patients.The CT findings mainly included ground glass opacities(GGOs)(n=10,76.9%),focal consolidation within GGOs(n=7,53.8%),thickened vascular bundle passing through the lesions(n=10,76.9%),bronchial wall thickening(n=12,92.3%),air bronchogram(n=10,76.9%),vacuole signs in the lesions(n=7,53.8%),fine reticulation and interlobular septal thickening(n=3,23.1%),reversed halo-sign(n=2,15.4%),crazy-paving pattern(n=2,15.4%),and pleural effusion(n=2,15.4%).Conclusions Most of our patients diagnosed with COVID-19 at PUMCH had a travel history to Wuhan or direct contact with patients from Wuhan.The first symptoms of COVID-19 mainly include fever and dry cough,along with normal or reduced counts of WBC and lymphocytes.CT may reveal that the lesions distribute along the bronchi and under the pleura;they are typically localized GGOs in the early stage but can become multiple GGOs and infiltrative consolidation in both lungs in the advanced stage.Scattered vacuole signs may be visible inside the lesions in some patients.


Risk of Severe COVID-19 in Patients with Inflammatory Bowel Disease in United States. A Multicenter Research Network Study


A case of Takotsubo cardiomyopathy with COVID 19


title: Management of Locally Advanced Rectal Cancer During The COVID-19 Pandemic: A Necessary Paradigm Change at Memorial Sloan Kettering Cancer Center

text: The COVID-19 pandemic will consume significant health care resources. Given concerns for rapidly rising infection rates in the US, impending staffing shortages, and potential for resource re-allocation, we rapidly re-evaluated our rectal cancer practice polices during this public health emergency. Previous to the pandemic we commonly utilized total neoadjuvant therapy (TNT) with a strong preference for long course chemoradiation (LCCRT). In the setting of the ongoing pandemic we now mandate short course radiation therapy (SCRT). Despite multiple randomized trials demonstrating no difference in locoregional recurrence, distant recurrence, or overall survival between SCRT and LRCCT, adaptation of SCRT in the United States has been low given concerns for less tumor downstaging and increased toxicity. In the setting of the ongoing and likely prolonged COVID-19 pandemic, we feel that these concerns must be re-evaluated, as SCRT presents a well-validated alternative that will allow us to meet the needs of a greater number of potentially curable patients, at a time when our resources are severely and acutely constrained.


Advanced renal cell carcinoma and COVID-19 - a personal perspective


Household Transmission of SARS-CoV-2 from Adults to Children


title: Loopholes in Current Infection Control and Prevention Practices Against COVID-19 in Radiology Department and Improvement Suggestions

text: OBJECTIVES: To improve the infection control and prevention practices against coronavirus disease 2019 (COVID-19) in radiology department through loophole identification and providing rectifying measurements. METHODS: Retrospective analysis of 2 cases of health-care-associated COVID-19 transmission in 2 radiology departments and comparing the infection control and prevention practices against COVID-19 with the practices of our department, where no COVID-19 transmission has occurred. RESULTS: Several loopholes have been identified in the infection control and prevention practices against COVID-19 of the 2 radiology departments. Loopholes were in large part due to our limited understanding of the highly contagious coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is characterized by features not observed in other SARS viruses. We recommend to set up an isolation zone for handling patients who do not meet the diagnostic criteria of COVID-19 but are not completely cleared of the possibility of infection. CONCLUSIONS: Loopholes in the infection control and prevention practices against COVID-19 of the 2 radiology departments are due to poor understanding of the emerging disease which can be fixed by establishing an isolation zone for patients not completely cleared of SARS-CoV-2 infection.


Modified tracheal extubation for patients with COVID-19


Guillain-Barré Syndrome in a Patient With Minimal Symptoms of COVID-19 Infection


docid: rfzqoqqz

title: Beware of Time Delay and Differential Diagnosis when Screening for Symptoms of COVID-19 in Surgical Cancer Patients


Abnormalities on chest computed tomography in patients with coronavirus disease 2019


Characteristics of Hospitalized Adults With COVID-19 in an Integrated Health Care System in California


title: Thoracic computerised tomography scans in one hundred eighteen orthopaedic patients during the COVID-19 pandemic: identification of chest lesions; added values; help in managing patients; burden on the computerised tomography scan department

text: PURPOSE: Based on the recent literature, chest computed tomography (CT) examination could aid for management of patients during COVID-19 pandemic. However, the role of chest CT in management of COVID-19 patients is not exactly the same for medical or surgical specialties. In orthopaedic or trauma emergency, abdomen, pelvis, cervical, dorsal, and lumbar spine CT are performed to investigate patients; the result is a thoracic CT scan incorporating usually the thorax; however, information about lung parenchyma can be obtained on this thorax CT, and manifestations of COVID-19 can be diagnosed. The objective of our study was to evaluate this role in orthopedic patients to familiarize orthopaedists with the value and limits of thoracic CT in orthopaedic surgery. MATERIALS AND METHODS: Among the 1397 chest CT scans performed during the pandemic period from 1 March 2020 to 10 May 2020, in two centres with orthopaedic surgery, we selected all the 118 thoracic or chest CT performed for patients who presented to the Emergency Department of the hospital with a diagnosis of trauma for orthopaedic surgical treatment. Thirty-nine of these 118 patients were tested with PCR for the diagnosis of COVID-19 infection. Depending on clinical status (symptomatic or non-symptomatic), the information useful for the orthopaedist surgeon and obtained from the Chest CT scan according to the result of the PCR (gold standard) was graded from 0 (no or low value) to 3 (high value). The potential risks of chest CT as exposure to radiation, and specific pathway were analyzed and discussed. A group of patients treated during a previous similar period (1 March 2018 to 15 April 2018) was used as control for evaluation of the increase of CT scanning during the COVID-19 pandemic. RESULTS: Among the 118 patients with chest CT, there were 16 patients with positive COVID-19 chest CT findings, and 102 patients with negative chest CT scan. With PCR results as reference, the sensitivity, specificity, positive predictive value of chest CT in indicating COVID-19 infection were 81%, 93%, and 86%, respectively (p = 0.001). A useful information for the orthopaedic surgeon (graded as 1 for 71 cases, as 2 for 5 cases, and as 3 for 11 cases) was obtained from 118 chest CT scans for 87 (74%) patients, while the CT was no value in 30 (25%) cases, and negative value in one (1%) case. Roughly 20% of the total number of CT scanner performed over the pandemic period was dedicated to COVID-19, but only 2% were for orthopaedic or trauma patients. However, this was ten times higher than during the previous control period of comparison. CONCLUSION: Although extremely valuable for surgery management, these results should not be overstated. The CT findings studied are not specific for COVID-19, and the positive predictive value of CT will be low unless disease prevalence is high, which was the case during this period.


Clinical phenotypes of critically ill COVID-19 patients


title: Potential lethal outbreak of coronavirus disease (COVID-19) among the elderly in retirement homes and long-term facilities, France, March 2020

text: Reports from the coronavirus disease (COVID-19) outbreak in China identified older age as a predictor of severity and mortality [1] A retrospective analysis of individual case data from China and elsewhere showed a very strong age gradient in the infection fatality ratio (IFR) and case fatality ratio (CFR) [2] In France, as at 15 March 2020, people older than 75 years accounted for 20% of the confirmed cases but 79% of the deaths [3] Cardiovascular diseases, hypertension and diabetes mellitus were the comorbidities most frequently associated with COVID-19, and many patients died of their original comorbidities [4,5] All these comorbidities are highly common among dependent elderly people housed in institutions Using simple calculation, we present here the impact of several worst-case scenarios in French institutions Potential number of deathsGo to section We studied different scenarios to simulate the potential death toll of an outbreak of COVID-19 in the French institutions in the absence of mitigation measures We extracted the age structure of residents from 40 “Habitat et Humanisme” institutions for dependent elderly people In France, at the end of 2017, 766,400 people above 60 years of age were housed in retirement homes for dependent elderly people, in long-term care facilities or received home-based care [6] While the calculation of IFR is based on the proportion of all infected cases, i e a precise estimation of the proportion of symptomatic and asymptomatic cases, we restricted our analysis to CFR The CFR, estimated from China and elsewhere, for 60–69 year-olds, 70–79 year-olds and those 80 years and older were, respectively, 3 6%, 8 0% and 14 8% [2] We applied the hypothesis that 30–50% of the institutions were infected, a final attack rate (AR) of 30–50% among the residents and applying age-specific fatality ratios, with their confidence intervals (CI), from [2] By the time the epidemic is over, the resulting death toll in these institutions could be equal to the yearly national death toll caused by seasonal influenza in those older than above 65 years (9,025 deaths on average between 2000 and 2009) or it could largely exceed that figure, depending on the final AR and the proportion of infected institutions (Table) [7] Among this frail population, part of this excess in mortality may be due to the acceleration of underlying unavoidable process and another part directly attributable to the infection


Commentary: Fool me once, shame on you, fool me twice, shame on me-preparing for acute aortic emergencies and the next wave of the COVID-19 pandemic


Coronavirus Disease (COVID-19) Pandemic: A Race Against Time


Emergency Endoscopy During the SARS-CoV-2 Pandemic in the North of Italy: Experience from St. Orsola University Hospital-Bologna


title: Learning to Forecast and Forecasting to Learn from the COVID-19 Pandemic

text: Accurate forecasts of COVID-19 is central to resource management and building strategies to deal with the epidemic. We propose a heterogeneous infection rate model with human mobility for epidemic modeling, a preliminary version of which we have successfully used during DARPA Grand Challenge 2014. By linearizing the model and using weighted least squares, our model is able to quickly adapt to changing trends and provide extremely accurate predictions of confirmed cases at the level of countries and states of the United States. We show that during the earlier part of the epidemic, using travel data increases the predictions. Training the model to forecast also enables learning characteristics of the epidemic. In particular, we show that changes in model parameters over time can help us quantify how well a state or a country has responded to the epidemic. The variations in parameters also allow us to forecast different scenarios such as what would happen if we were to disregard social distancing suggestions.


title: Forecast of the evolution of the contagious disease caused by novel coronavirus (2019-nCoV) in China

text: The outbreak of novel coronavirus (2019-nCoV) in China has caused a viral epidemic affecting tens of thousands of persons. Though the danger of this epidemic is evident, the statistical analysis of data offered in this paper indicates that the increase in new cases in China will stabilize in the coming days or weeks. Our forecast could serve to evaluate risks and control the evolution of this disease.


docid: nforhbjz

title: Challenges to Neurosurgery During the Coronavirus Disease 2019 (COVID-19) Pandemic

text: The coronavirus disease 2019 pandemic has presented a massive burden to most health care systems across the globe. The demand for intensive care unit capacity in particular has increased significantly, and hospitals in most affected regions have struggled to cope. The focus of health care activity has shifted to the pandemic, with a negative impact on the management of other conditions. Neurosurgery, like most specialties, has been drastically affected but, arguably, warrants special considerations because many of the treatments required are time-critical. Lack or delay of appropriate intervention may lead, for an individual patient, to permanent neurologic injury and a significant decline in function and quality of life, or even death. In this report, we consider the challenges that neurosurgeons currently face in relation to the pandemic and are likely to face in the foreseeable future. The challenges are multifaceted with practical, ethical, legal, and other implications. These include re-deployment of staff to areas outside neurosurgery, treatment priority setting, ethical decision-making and risk of moral injury, as well as medicolegal risks, financial uncertainties and implications for training, research, and global health work. As well as patients, these challenges will affect neurosurgeons as doctors and as humans. The international neurosurgical community has a moral duty to contribute to the global response to the COVID-19 crisis, but also to retain a duty to care for individual patients.


title: The Effect of the COVID-19 Pandemic on Physicians' Use and Perception of Telehealth: The Case of Lebanon

text: The COVID-19 pandemic forced physicians to quickly adapt and find ways to provide their usual offline services by using online tools. We aimed to understand how physicians adapted to the sudden need for telehealth and if their perception of telehealth changed due to their experience during the COVID-19 pandemic. We conducted an exploratory sequential mixed-methods study. We interviewed five Lebanese physicians and thematically analyzed the interviews. We developed a questionnaire based on the analysis results and administered it online to physicians in Lebanon. In total, 140 responses were collected. We found that, during the COVID-19 pandemic, physicians engaged in more telehealth activities in the realms of telemedicine, public awareness, continuing medical education, research, administration, and teaching. They also expanded their repertoire of information-technology tools. Our results also show that there was a significant shift in the physicians' perceptions, indicating greater openness and willingness to adopt telehealth services. However, a significant amount of skepticism and uncertainty regarding telemedicine remains, especially concerning its efficiency, safety, and the adequacy of existing regulations. Based on our findings, we offer recommendations for health IT policy makers, developers, and researchers, to sustain the continuity of telehealth activities beyond the COVID-19 pandemic.


docid: kcimahsa

title: Mechanism of thrombocytopenia in COVID-19 patients

text: Since December 2019, a novel coronavirus has spread throughout China and across the world, causing a continuous increase in confirmed cases within a short period of time. Some studies reported cases of thrombocytopenia, but hardly any studies mentioned how the virus causes thrombocytopenia. We propose several mechanisms by which coronavirus disease 2019 causes thrombocytopenia to better understand this disease and provide more clinical treatment options.


docid: xqmugkvy

title: Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020

text: There are few detailed investigations of neurologic complications in severe acute respiratory syndrome coronavirus 2 infection. We describe 3 patients with laboratory-confirmed coronavirus disease who development of encephalopathy and encephalitis. Neuroimaging showed nonenhancing unilateral, bilateral, and midline changes not readily attributable to vascular causes. All 3 patients had increased cerebrospinal fluid (CSF) levels of anti-S1 IgM. One patient who died also had increased levels of anti-envelope protein IgM. CSF analysis also showed markedly increased levels of interleukin (IL)-6, IL-8, and IL-10, but severe acute respiratory syndrome coronavirus 2 was not identified in any CSF sample. These changes provide evidence of CSF periinfectious/postinfectious inflammatory changes during coronavirus disease with neurologic complications.


title: Diabetes self-management amid COVID-19 pandemic

text: BACKGROUND AND AIMS: COVID-19 pandemic has challenged the physician-centered approach of diabetes care in India that is primarily based on routine clinic visits. We aim to review the various aspects of patient-centered care via diabetes self-management education based on available literature. METHODS: This is a narrative review using Pubmed, EMBASE and Google Scholar search till March 29, 2020. Search terms were "COVID-19", "diabetes self-care", "diabetes self-management education", "DSME", "diabetes self-management in India", "diabetes self-care in India" and "DSME in India". RESULTS: We have discussed an educational plan on diabetes self-management that can be adopted for people with diabetes mellitus in our country amid the ongoing pandemic. We have also identified the barriers to diabetes self-management in the current scenario and suggested possible solutions to overcome those. CONCLUSIONS: We have reemphasized the need for a simultaneous patient-centered approach in routine diabetes care that has to be coordinated by a multidisciplinary team amid the ongoing COVID-19 pandemic.


Compassion, resilience and COVID-19


title: Site-specific glycan analysis of the SARS-CoV-2 spike

text: The emergence of the betacoronavirus, SARS-CoV-2, the causative agent of COVID-19, represents a significant threat to global human health. Vaccine development is focused on the principal target of the humoral immune response, the spike (S) glycoprotein, which mediates cell entry and membrane fusion. SARS-CoV-2 S gene encodes 22 N-linked glycan sequons per protomer, which likely play a role in protein folding and immune evasion. Here, using a site-specific mass spectrometric approach, we reveal the glycan structures on a recombinant SARS-CoV-2 S immunogen. This analysis enables mapping of the glycan-processing states across the trimeric viral spike. We show how SARS-CoV-2 S glycans differ from typical host glycan processing, which may have implications in viral pathobiology and vaccine design.


Online management of rheumatoid arthritis during COVID-19 pandemic


title: [Analysis of bronchoscope-guided tracheal intubation in 12 cases with coronavirus disease 2019 under the personal protective equipment with positive pressure protective hood]

text: Endotracheal intubation is an independent risk factor for respiratory infectious diseases. We conducted a retrospective study in 12 cases with COVID-19 who underwent endotracheal intubation at ICU of the Guangzhou eighth hospital from January 20 to February 10, 2020. The intubation procedure, anesthetic regimen, and complication were collected and analyzed. The 9 healthcare workers who involved in intubation received virus nucleic acid test and 14 days temperature monitoring. All 12 patients were successfully intubated under the guidance of bronchoscope, without any complications. Midazolam, Propofol and Morphine or fentanyl were used for sedation and analgesia, avoiding patients cough and agitated during the procedure. The 9 healthcare workers were protected under the Personal Protective Equipment(PPE) with positive pressure protective hood. The detection of oropharyngeal swab virus nucleic acid were negative in all 9 healthcare workers, none of them had fever or any respiratory symptoms. The PPE with positive pressure protective hood should be needed to perform bronchoscope-guided endotracheal intubation in patients with COVID-19, it could strengthen to protect healthcare workers from virus exposure.


title: Coronavirus (COVID-19) Infection-Induced Chilblains: A Brisk Perieccrine Inflammatory Response

text: The varying cutaneous and pathological manifestations of coronavirus 2 (SARS-CoV-2 or COVID-19) may have prognostic implications. Acral ischemic findings present with a hypercoagulable state in critically ill COVID-19 patients. Pathologically confirmed varicella-like exanthem and perniosis COVID-19 cases have correlated with paucisymptomatic and asymptomatic patients in previous reports. We present the second case of biopsy-proven COVID-19 infection-induced chilblains (pernio) in a paucisymptomatic patient with a brisk perieccrine lymphocytic response. Based on an antecedent pathological study, we know coronavirus particles have been seen in the eccrine gland associated with a brisk peri-inflammatory response. The prominent perieccrine inflammation is helpful in the diagnosis of COVID-19 infections. Currently, nonischemic pathological findings correlate with a good prognosis based on the paucisymptomatic or asymptomatic nature of their disease courses. Patients presenting with suspected COVID-19 infection-induced chilblains who are paucisymptomatic or asymptomatic should be isolated and immediately tested with polymerase chain reaction (PCR) testing (as there is a delay in diagnosis based on the poor sensitivity of the current rapid test). We continue to stress the importance of early diagnosis and quarantining to prevent spread to the older and immunocompromised patients.


docid: fspfzbvc

title: COVID-19 and diabetes: Can DPP4 inhibition play a role?


title: Exponential-growth prediction bias and compliance with safety measures in the times of COVID-19

text: We conduct a unique, Amazon MTurk-based global experiment to investigate the importance of an exponential-growth prediction bias (EGPB) in understanding why the COVID-19 outbreak has exploded. The scientific basis for our inquiry is the well-established fact that disease spread, especially in the initial stages, follows an exponential function meaning few positive cases can explode into a widespread pandemic if the disease is sufficiently transmittable. We define prediction bias as the systematic error arising from faulty prediction of the number of cases x-weeks hence when presented with y-weeks of prior, actual data on the same. Our design permits us to identify the root of this under-prediction as an EGPB arising from the general tendency to underestimate the speed at which exponential processes unfold. Our data reveals that the"degree of convexity"reflected in the predicted path of the disease is significantly and substantially lower than the actual path. The bias is significantly higher for respondents from countries at a later stage relative to those at an early stage of disease progression. We find that individuals who exhibit EGPB are also more likely to reveal markedly reduced compliance with the WHO-recommended safety measures, find general violations of safety protocols less alarming, and show greater faith in their government's actions. A simple behavioral nudge which shows prior data in terms of raw numbers, as opposed to a graph, causally reduces EGPB. Clear communication of risk via raw numbers could increase accuracy of risk perception, in turn facilitating compliance with suggested protective behaviors.


docid: riasjtuo

title: The reproductive number R0 of COVID-19 in Peru: An opportunity for effective changes


title: Protecting health during COVID-19 and beyond: A global examination of paid sick leave design in 193 countries

text: Well-designed paid sick leave is critical to ensure workers stay home when sick to prevent the spread of SARS-CoV-2 and other infectious pathogens, both when the economy is open and during an economic shutdown. To assess whether paid sick leave is available in countries around the world, we created and analysed a database of legislative guarantees of paid leave for personal illness in 193 UN member states. Original labour and social security legislation and global information on social security systems for each country were obtained and analysed by a multilingual research team using a common coding framework. While strong models exist across low- middle- and high-income countries, critical gaps that jeopardise health and economic security remain. 27% of countries do not guarantee paid sick leave from the first day of illness, essential to encouraging workers to stay home when they are sick and prevent spread. 58% of countries do not have explicit provisions to ensure self-employed and gig economy workers have access to paid sick leave benefits. Comprehensive paid sick leave policies that cover all workers are urgently needed if we are to reduce the spread of COVID-19, and be ready to respond to threats from new pathogens.


Fighting the battle against SARS-CoV-2 as gastroenterologists in Italy


title: Rhabdomyolysis as an initial presentation in a patient diagnosed with COVID-19

text: The presence of rhabdomyolysis secondary to multiple infections has been reported, predominantly viral, but also bacterial and fungal. It is well known that COVID-19 can present a wide variety of complications during the course of infection; however, the presence of rhabdomyolysis as an initial condition has not been reported so far. We report a case of rhabdomyolysis as an initial presentation in a patient diagnosed with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection.


Dyspnea rather than fever is a risk factor for predicting mortality in patients with COVID-19


title: Glycaemic Control Among People with Type 1 Diabetes During Lockdown for the SARS-CoV-2 Outbreak in Italy

text: Introduction: In late February 2020, due to the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the Italian Government closed down all educational and sport activities. In March, it introduced further measures to stop the spread of coronavirus disease (COVID-19), placing the country in a state of almost complete lockdown. We report the impact of these restrictions on glucose control among people with type 1 diabetes (T1D). Methods: Data were collected on 33 individuals with T1D who were monitoring their glucose levels using a flash glucose monitoring device and remotely connected to the diabetes clinic on a cloud platform. We retrieved information on average glucose, standard deviation and percentage time in hypoglycaemia (< 70 mg/dl), glucose range (70-180 mg/dl) and hyperglycaemia (> 180 mg/dl). We compared glycaemic measures collected during lockdown to those collected before the SARS-CoV-2 epidemic and to the periods immediately before lockdown. Results: In 20 patients who had stopped working and were at home as a result of the lockdown, overall glycaemic control improved during the first 7 days of the lockdown as compared to the weeks before the spread of SARS-CoV-2. Average glucose declined from 177 ± 45 mg/dl (week before lockdown) to 160 ± 40 mg/dl (lockdown; p = 0.005) and the standard deviation improved significantly. Time in range increased from 54.4 to 65.2% (p = 0.010), and time in hyperglycaemia decreased from 42.3 to 31.6% (p = 0.016). The number of scans per day remained unchanged. In 13 patients who continued working, none of the measures of glycaemic control changed during lockdown. Conclusion: Despite the limited possibility to exercise and the incumbent psychologic stress, glycaemic control improved in patients with T1D who stopped working during the lockdown, suggesting that slowing down routine daily activities can have beneficial effects on T1D management, at least in the short term.


title: Topological analysis of SARS CoV-2 main protease

text: There is an urgent necessity of effective medication against severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), which is producing the COVID-19 pandemic across the world. Its main protease (Mpro) represents an attractive pharmacological target due to its involvement in essential viral functions. The crystal structure of free Mpro shows a large structural resemblance with the main protease of SARS CoV (nowadays known as SARS CoV-1). Here, we report that average SARS CoV-2 Mpro is 1900% more sensitive than SARS CoV-1 Mpro in transmitting tiny structural changes across the whole protein through long-range interactions. The largest sensitivity of Mpro to structural perturbations is located exactly around the catalytic site Cys-145 and coincides with the binding site of strong inhibitors. These findings, based on a simplified representation of the protein as a residue network, may help in designing potent inhibitors of SARS CoV-2 Mpro.


title: SARS-CoV-2 in the semen: where does it come from?

text: A recent report by Li et al., described the presence of SARS-CoV-2 in semen samples of six patients, including two subjects who were recovering from the clinical disease. This finding re-opened the discussion on possible male genital tract infection, virus shedding in semen, sexual transmission and safety of fertility treatments during the pandemic period [1]. As stated by the Authors themselves, the small sample size and short follow up dictate caution in the interpretation of their results.


A simple negative-pressure protective barrier for extubation of COVID-19 patients


Active and Effective Measures for the Care of Patients With Cancer During the COVID-19 Spread in China


title: Investigation of the mental health of patients with novel coronavirus pneumonia/ 中华神经科杂志

text: Objective@#To evaluate the status and influencing factors of the mental health of patients with COVID-19 during isolation treatment.@* Methods@#From February 2nd to 16th, 2020, 106 COVID-19 patients were anonymously investigated for their mental health status using onlinequestionnaires (including Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, Patient Health Questionnaire-15 scales). The patients were from Tongji Hospital Affiliated to Tongji Medical College ofHuazhong University of Science and Technology. After data processing, SPSS19.0 was used for statistical analysis.@* Results@#Of the 106 COVID-19 patients, 46 were male and 60 were female, with an age of (35.90±11.92) years. The detection rates of depression, anxiety and somatic symptoms in those patients were 49.06% (52/106) , 56.60% (60/106) and 69.81% (74/106) respectively. The severe cases of depression (scale score greater than 19) , anxiety (scale score greater than 14) and somatic symptoms (scale score greater than 14) accounted for 9.43% (10/106) , 15.09% (16/106) and 20.75% (22/106) respectively. In addition, 67.92% (72/106) of the patients had sleep problems, 24.53% (26/106) had self-mutilating or suicidal thoughts, and 28.30% (30/106) required psychological counseling—all of which were at significantly higher percentages than those of the general population. Only 39.62% (42/106) of the examined patients had neither deression nor anxiety. By using the non-parametric test of rank conversion for analysis, and the results showed that both married patients and nucleic-acid-positive patients had more severe depressions, and both married patients and anoxemicpatients had more severe somatic symptoms.@*Conclusion@#This mental health assessment showed that depression, anxiety, and various somatic symptoms exist among the COVID-19 patients, and therefore early identification and intervention should be conducted to avoid extreme events such asself-mutilating or suicidal impulsivity, with a greater focus on both married patients and patients with severe symptoms.


title: Surgical tracheostomies in Covid-19 patients: important considerations and the "5Ts" of safety

text: The coronavirus disease (covid19) pandemic (caused by the SARS-CoV-2 virus) is the greatest healthcare challenge in a generation. Clinicians are modifying the way they approach day-to-day procedures. Safety and reduction of transmission risk is paramount. Surgical tracheostomies in covid19 patients are aerosol generating procedures linked with a significant risk of viral contamination. Here, we describe our local approach for these procedures, introducing the "5Ts" of safe tracheostomy practice: Theatre set-up, Team Briefing, Transfer of patient, Tracheostomy Procedure, Team Doffing and De-brief. We identify the critical steps of the procedure and explain how we overcome the risks associated with breaking the transfer circuit to attach the patient to the theatre ventilator. We explain our technique to reduce secretion spillage when opening the trachea. We emphasise the importance of closed tracheal suctioning and mouth suctioning prior to patient transfer. We highlight the importance of maintaining a closed circuit throughout the procedure and describe tips on how to achieve this. We summarise the steps of our protocol in an "easy to reproduce" way. Finally, we emphasise the importance of communication in a constantly changing environment and challenging circumstances.


COVID-19 experience reports: an emerging trend in scholarly communication


Key Highlights From the Canadian Thoracic Society's Position Statement on Optimizing the Management of Sleep Disordered Breathing During the COVID-19 Pandemic


title: Psychological needs and response during the COVID-19 pandemic in Lebanon

text: Lebanon was 1 of the countries to be affected early by the COVID-19 pandemic while in the midst of political upheaval. The stress implicated by this dual challenge allowed for mental health to take a center stage, prompting a nationwide official and informal response. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Re-starting Travel in the Era of COVID-19: Preparing Anew


The COVID-19 pandemic


Detection of Covid-19 in Children in Early January 2020 in Wuhan, China


title: Statistical Disclosure Control via Information Theory

text: Differential privacy is a strong privacy model based on indistinguishability of statistical outputs of two neighboring datasets, which represent two states that an individual's information is within or without a dataset. However, when the informations of different individuals are dependent, the representation would lose its foundation. In order to remedy the drawback of differential privacy, we revisit the Dalenius' paper [1] that motivates differential privacy, and introduce a new privacy model to control individual's information disclosure. The rationality of the privacy model is based on the information theory, i.e., the mutual information of one individual's information and the statistical outputs is upper bounded by a small value. The new privacy model accurately captures the weakness of differential privacy when dealing with dependent informations. Furthermore, the new privacy model gets on well with differential privacy. When the informations of individuals are independent, we prove that a mechanism that satisfies $\epsilon$-differential privacy would ensure to satisfy the new privacy model. When the informations of individuals are dependent, we prove that the group privacy method to achieve differential privacy in dependent case can be used to achieve the new privacy model. When the dependence extents of the informations of individuals are weak, we find differentially private mechanism which can satisfy the new privacy model with noise magnitude far less than the mechanism based on the group privacy based method. These results imply that the new model inherits (almost) all of the mechanisms of differential privacy.


title: Coronavirus disease 2019 (COVID-19) pneumonia in a hemodialysis patient: A case report

text: RATIONALE: The 2019 novel coronavirus disease (COVID-19) causes a novel, atypical pneumonia that has brought huge public health challenges across the globe. There is limited data about patients with end-stage renal disease who also suffer from COVID-19. In this report, we discuss the case of a hemodialysis patient who developed COVID-19 pneumonia in the clinical course. PATIENT CONCERNS: A 79-year-old man who had end-stage renal disease (ESRD) and was taking regular hemodialysis was admitted to hospital for a fever and dry cough. The patient, who also had cardiovascular disease, had no history of contact with COVID-2019 patients. DIAGNOSIS: The patient was diagnosed with COVID-2019 by the reverse-transcriptase polymerase chain reaction (RT-PCR), and his pharyngeal swab for SARS-CoV-2 was positive. INTERVENTION: The treatment was mainly supportive and the patient was intensively monitored. He was treated with oxygen, broad-spectrum antibiotics, antiviral drugs, and methylprednisolone. The patient took continuous renal replacement therapy (CRRT) every 2 days. OUTCOMES: After 19 days, an RT-PCR assay for SARS-CoV-2 was negative, and computed tomography (CT) of the patient's thorax indicated that the pulmonary inflammatory exudation was absorbed and pulmonary infection improved significantly. He was discharged on day 29 after recovering from COVID-2019 pneumonia. LESSONS: The courses of disease and treatment options for this individual were significantly more complicated than those for ordinary patients. Therefore, it was necessary to monitor the condition of the patient closely and to protect the dialysis unit staff from being infected. Compared with other severe COVID-2019 cases, this patient recovered more quickly following treatment, which was likely due to the removal of inflammatory mediators by CRRT. This implies that blood purification might be an important option for hemodialysis patients with COVID-19.


Commentary: Let's start again!


docid: dgkmniex

title: Overview of transnational recommendations for COVID-19 transmission control in dental care settings

text: On 11 March 2020, the World Health Organization (WHO) declared the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) as a pandemic. Until an effective treatment or a vaccine is developed, the current recommendations are to contain the disease, and control its transmission. It is now clear that the primary mode of SARS-CoV-2 transmission is aerosol/droplet spread, and by contacting virus-contaminated surfaces acting as fomites (inanimate vectors). Furthermore, recent data indicate that the live virus particles are present in saliva, and, more alarmingly, asymptomatic individuals may transmit the infection. By virtue of the nature of the practice of dentistry where intrinsically, a high volume of aerosols is produced, as well as the close proximity of dentists and patients during treatment, dentists and allied health staff are considered the highest risk health professional group for acquiring SARS-CoV-2 during patient management. Therefore, several organizations and specialty associations have proposed guidelines and recommendations for limiting the transmission of SARS-COV-2 from carriers to dentists and vice versa. This paper aims to provide a review of these guidelines, and concludes with a brief look at how the practice of dentistry may be impacted by COVID-19, in the post-pandemic era.


title: Platelet functions and activities as potential hematologic parameters related to Coronavirus Disease 2019 (Covid-19)

text: Coronavirus disease 2019 (COVID-19) is a new infectious disease that currently lacks standardized and established laboratory markers to evaluate its severity. In COVID-19 patients, the number of platelets (PLTs) and dynamic changes of PLT-related parameters are currently a concern. The present paper discusses the potential link between PLT parameters and COVID-19. Several studies have identified a link between severe COVID-19 patients and specific coagulation index, in particular, high D-dimer level, prolonged prothrombin time, and low PLT count. These alterations reflect the hypercoagulable state present in severe COVID-19 patients, which could promote microthrombosis in the lungs, as well as in other organs. Further information and more advanced hematological parameters related to PLTs are needed to better estimate this link, also considering COVID-19 patients at different disease stages and stratified in different cohorts based on preexisting co-morbidity, age, and gender. Increasing the understanding of PLT functions in COVID-19 will undoubtedly improve our knowledge on disease pathogenesis, clinical management, and therapeutic options, but could also lead to the development of more precise therapeutic strategies for COVID-19 patients.


Society of NeuroInterventional Surgery recommendations for the care of emergent neurointerventional patients in the setting of COVID-19


title: COVID-19 not detected in peritoneal fluid: a case of laparoscopic appendicectomy for acute appendicitis in a COVID-19-infected patient

text: PURPOSE: COVID-19 greatly affected millions and affected the way we practice with heightened posture in the way we treat surgical patients. Surgical consensus guidelines are recommending caution in the use of laparoscopy for the theoretical possibility of viral transmission from aerosolization of tissue and peritoneal fluid during surgery. However, there has yet to be proof of COVID-19 being present in peritoneal fluid, justifying the consensus statements. We aim to assess the presence of COVID-19 in peritoneal fluid. METHODS: We performed a laparoscopic appendicectomy for a COVID-19-infected patient with acute appendicitis. Peritoneal fluid and peritoneal washings were collected and sent for COVID-19 PCR. RESULTS: The peritoneal fluid sample collected on entry and at the end of the operation was negative for COVID-19 on PCR. The patient had an uneventful recovery from surgery. CONCLUSIONS: This case revealed that COVID-19 was not detected in peritoneal fluid and peritoneal washings in a patient infected with COVID-19. This study provides novel preliminary data in the investigation of COVID-19 transmission from laparoscopy-related aerosolization.


title: Patients with COVID-19 and neurological manifestations show undetectable SARS-CoV-2 RNA levels in the cerebrospinal fluid

text: We report that patients with COVID-19 displaying distinct neurological disorders have undetectable or extremely low levels of SARS-CoV-2 RNA in the cerebrospinal fluid, indicating that viral clearance precede the neurological involvement. This finding points to the need for the development of more sensitive molecular tests and the investigation of other neurotropic pathogens to exclude concurrent neuroinfection.


COVID-19, internists and resilience: the north-south Italy outbreak


title: How to manage lymphoid malignancies during novel 2019 coronavirus (CoVid-19) outbreak: a Brazilian task force recommendation

text: The novel Coronavirus (CoVid-19) outbreak is now consider a world pandemic, affecting more than 300,000 people worldwide. Cancer patients are in risk for severe disease, including a higher risk of intensive care unit (ICU) admission, need for invasive ventilation or death. Management of patients with lymphoid malignancies can be challenging during the outbreak, due to need of multiple hospital visits and admissions, immunosuppression and need for chemotherapy, radiotherapy and stem cell transplantation. In this article, we will focus on the practical management of patients with lymphoid malignancies during the COVID-19 pandemic, focusing on minimizing the risk for patients.


title: COVID-19 y enfermedad inflamatoria intestinal: preguntas surgidas de la atención y seguimiento de los pacientes durante la fase inicial de la pandemia (febrero-abril 2020)./ [COVID-19 and inflammatory bowel disease: questions arising from patient care and follow-up during the initial phase of the pandemic (February-April 2020)]

text: COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was described in China in late 2019. There are currently more than three million diagnosed cases, constituting a pandemic which has caused a worldwide crisis. The devastating effects of this infection are due to its highly contagious nature and although mild forms predominate, in absolute values, the rates for severe forms and mortality are very high. The information on the characteristics of the infection in inflammatory bowel disease is of special interest, as these patients have higher attendance at health centres, which may increase their risk of infection. Furthermore, the treatments used to control the inflammatory activity may modify the disease course of COVID-19. The Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) and the Spanish Nurses Working Group on Inflammatory Bowel Disease (GETEII) have prepared this document as a practical response to some common questions about the treatment of these patients.


Spine fellowship training reorganizing during a pandemic: perspectives from a tertiary orthopedic specialty center in the epicenter of outbreak


title: Corona Viruses and the Chemical Senses: Past, Present, and Future

text: A wealth of rapidly evolving reports suggests that olfaction and taste disturbances may be manifestations of the novel COVID-19 pandemic. While otolaryngological societies worldwide have started to consider chemosensory evaluation as a screening tool for COVID-19 infection, the true nature of the relationship between the changes in chemosensory ability and COVID-19 is unclear. Our goal with this review is to provide a brief overview of published and archived literature, as well as the anecdotal reports and social trends related to this topic up to April 29, 2020. We also aim to draw parallels between the clinical/chemosensory symptomology reported in association to past coronavirus pandemics (such as SARS and MERS) and the novel COVID-19. This review also highlights current evidence on persistent chemosensory disturbances after the infection has resolved. Overall, our analysis pinpoints the need for further studies: 1) to better quantify olfaction and taste disturbances associated with SARS-CoV-2 infection, compared to those of other viral and respiratory infections, 2) to understand the relation between smell, taste, and chemesthesis disturbances in COVID-19, and 3) to understand how persistent are these disturbances after the infection has resolved.


Surgical Response to COVID-19 Pandemic: A Singapore Perspective


Expression of ACE2, the SARS-CoV-2 Receptor, and TMPRSS2 in Prostate Epithelial Cells


QTc evaluation in COVID-19 patients treated with chloroquine/hydroxychloroquine


title: Could Sex/Gender Differences in ACE2 Expression in the Lungs Contribute to the Large Gender Disparity in the Morbidity and Mortality of Patients Infected With the SARS-CoV-2 Virus?

text: COVID-19 morbidity and mortality have significant gender disparities, with higher prevalence and mortality in men. SARS-CoV-2 enters the lungs through the ACE2 enzyme, a member of the renin-angiotensin system (RAS). Although there are no data for the lung, the expressions of RAS components in other tissues are modulated by sex hormones, androgens, and estrogens. However, there are no data on sex-specific differences in ACE2 expression. If there is a sex difference in the expression of ACE2 in the lung, this could theoretically explain the gender disparity in COVID-19 disease. More importantly, although modulation of ACE2 will certainly not provide a cure for the COVID-19 disease, modulation of ACE2 by sex hormone modulators, if they affect the expression of ACE2, could potentially be developed into a supportive therapy for COVID-19 patients.


docid: sjvenojo

title: The Swiss approach to the COVID-19 outbreak