title: Genetic variation in toll like receptors 2, 7, 9 and interleukin-6 is associated with cytomegalovirus infection in late pregnancy

text: BACKGROUND: Maternal cytomegalovirus (CMV) infection and/or reactivation in pregnancy is associated with a myriad of adverse infant outcomes. However, the role of host genetic polymorphisms in modulating maternal CMV status is inconclusive. This study investigated the possible association of single nucleotide polymorphisms in toll-like receptor (TLR) and cytokine genes with maternal plasma CMV DNA status in black Zimbabweans. METHODS: In a cross-sectional study, 110 women in late gestation who included 36 CMV infected cases and 74 CMV uninfected, age and HIV status matched controls were enrolled. Twenty single nucleotide polymorphisms in 10 genes which code for proteins involved in immunity against CMV were genotyped using Iplex GOLD SNP genotyping protocol on the Agena MassARRAY® system. Statistical analyses were performed using Stata SE and the 'Genetics' and 'SNPassoc' packages of the statistical package R. RESULTS: The TLR7 rs179008A > T (p < 0.001) polymorphism was associated while the TLR9 rs352139T > C (p = 0.049) polymorphism was on the borderline for association with CMV positive (CMV+) status. In contrast, the interleukin (IL)-6 rs10499563T > C (p < 0.001) and TLR2 rs1816702C > T (p = 0.001) polymorphisms were associated with CMV negative (CMV-) status. Furthermore, allele frequencies of SNPs in TLR2, TLR4, TLR9, TLR7, IL-6, IL-10, IL-28B, IL-1A and interferon AR1 (IFNAR1) genes are being reported here for the first time in a Zimbabwean population. The allele frequencies in the Zimbabwean population are generally comparable to other African populations but different when compared to European and Asian populations. CONCLUSIONS: Toll-like receptor and interleukin genetic polymorphisms influence CMV status in late gestation among black Zimbabweans. This is attributable to possible modulation of immune responses to CMV reactivation in a population previously exposed to CMV infection.


title: Detection of SARS-CoV-2 in Fecal Samples from Patients with Asymptomatic and Mild COVID-19 in Korea

text: BACKGROUND & AIMS: Although COVID-19 is characterized by fever and respiratory symptoms, some patients have no or mild symptoms. SARS-CoV-2 has been detected in feces of patients. We investigated gastrointestinal symptoms and shedding of virus into feces of patients with asymptomatic or mild COVID-19. METHODS: We collected data from 46 patients (median age, 26 years; 46% men) with asymptomatic or mild COVID-19 (without fever and pneumonia) and prolonged respiratory shedding of SARS-CoV-2, quarantined from April 4, 2020 through April 24, 2020 in Korea. Respiratory specimens included upper respiratory specimens (nasopharyngeal and oropharyngeal swabs) and lower respiratory specimens (sputum) and were collected twice per week. The median interval between COVID-19 diagnosis to the start of fecal sample collection was 37 days (range, 29-41); 213 stool specimens were collected from 46 patients. We used real-time reverse transcription PCR to detect SARS-CoV-2 in the respiratory and fecal specimens. RESULTS: Gastrointestinal manifestations were observed in 16 of the 46 patients (35%); diarrhea was the most common (15%), followed by abdominal pain (11%), dyspepsia (11%), and nausea (2%). Virus RNA was detected in feces from 2 patients without gastrointestinal symptoms (4%). Mean cycle threshold values from the time of quarantine to the time of fecal collection tended to be lower in patients with virus detected in fecal samples than patients without virus in fecal samples (29.91 vs 33.67 in the first week; 29.47 vs 35.71 in the fifth week, respectively). Shedding of virus into feces persisted until day 50 after diagnosis; fecal samples began to test negative before or at approximately the time that respiratory specimens also began to test negative. CONCLUSIONS: In an analysis of fecal and respiratory specimens from patients with COVID-19 in quarantine in Korea, we found that the gastrointestinal tract could be a route of transmission of SARS-CoV-2 even in patients with asymptomatic or mild disease, with no gastrointestinal symptoms. The viral load of the respiratory specimens appears be related to shedding of the virus into feces in this group of patients.


title: COVID-19 outbreak reproduction number estimations and forecasting in Marche, Italy

text: BACKGROUND: COVID-19 disease is becoming a global pandemic and more than 200 countries were affected because of this disease. Italy is one of the countries is largely suffered with this virus outbreak, and about 180,000 cases (as of 20 April 2020) were registered which explains the large transmissibility and reproduction case numbers. OBJECTIVE: In this study, we considered the Marche region of Italy to compute different daily transmission rates (Rt) including five provinces in it. We also present forecasting of daily and cumulative incidences associated after the next thirty days. The Marche region is the 8th in terms of number of people infected in Italy and the first in terms of diffusion of the infection among the 4 regions of the center of Italy. METHODS: Epidemic statistics were extracted from the national Italian Health Ministry website. We considered outbreak information where the first case registered in Marche with onset symptoms (26 February 2020) to the present date (20 April 2020). Adoption of incidence and projections with R statistics was done. RESULTS: The median values of Rt for the five provinces of Pesaro and Urbano, Ancona, Fermo, Ascoli Piceno, and Macerata, was 2.492 (1.1-4.5), 2.162 (1.0-4.0), 1.512 (0.75-2.75), 1.141 (1.0-1.6), and 1.792 (1.0-3.5) with 95% of CI achieved. The projections at end of 30th day of the cumulative incidences 323 (95% CI), and daily incidences 45 (95% CI) could be possible. CONCLUSIONS: This study highlights the knowledge of essential insights into the Marche region in particular to virus transmission dynamics, geographical characteristics of positive incidences, and the necessity of implementing mitigation procedures to fight against the COVID-19 outbreak.


Comment of the potential risks of sexual and vertical transmission of Covid-19 infection


title: Determination of an Optimal Control Strategy for Vaccine Administration in COVID-19 Pandemic Treatment

text: During decades, mathematical models have been used to predict the behavior of physical and biologic systems, and to define strategies aiming the minimization of the effects regarding different types of diseases. In the present days, the development of mathematical models to simulate the dynamic behavior of novel coronavirus disease (COVID-19) is considered an important theme due to the quantity of infected people worldwide. In this work, the aim is to determine an optimal control strategy for vaccine administration in COVID-19 pandemic treatment considering real data from China. For this purpose, an inverse problem is formulated and solved in order to determine the parameters of the compartmental SIR (Susceptible-Infectious-Recovered) model. To solve such inverse problem, the Differential Evolution (DE) algorithm is employed. After this step, two optimal control problems (mono- and multi-objective) to determine the optimal strategy for vaccine administration in COVID-19 pandemic treatment are proposed. The first consists of minimizing the quantity of infected individuals during the treatment. The second considers minimizing together the quantity of infected individuals and the prescribed vaccine concentration during the treatment, i.e., a multi-objective optimal control problem. The solution of each optimal control problems is obtained using DE and Multi-Objective Differential Evolution (MODE) algorithms, respectively. The results regarding the proposed multi-objective optimal control problem provides a set of evidences from which an optimal strategy for vaccine administration can be chosen, according to a given criterion.


title: Are you surgically current? Lessons from aviation for returning to non-urgent surgery following COVID-19

text: The COVID-19 crisis has caused many issues across healthcare. In surgery, many operations have been cancelled with some surgeons losing their regular operating lists. During this time, technical expertise and decision making can deteriorate. In aviation after a prolonged period of absence from flying, this deficit in keeping skills and thinking up to date is known as being "out of currency" or "not current". Although aviation and healthcare cannot be compared, numerous human factors concepts are applicable to both. In this article, we explore the likely impact of potentially prolonged absences in operating on surgical skills and psyche, and introduce the concept of a Surgical Skills Currency Barometer. We also discuss a "task-o-meter" thought experiment, and suggest practices which could be adopted to help protect surgeon workload from exceeding surgical capability when returning to operating following a period of prolonged absence.


Protecting "covid protected" cancer hubs


title: Severe Thrombocytopenia in a Patient with COVID-19

text: Coronavirus disease 2019 (COVID-19) outbreak is spreading rapidly all over the world, being a major threat to public health. Since clinical feature of COVID-19 has not been fully evaluated yet, empirical antibacterial agents are frequently combined for the treatment of COVID-19 in addition to antiviral agents, concerning co-existing bacterial pathogens. We experienced a case of severe thrombocytopenia with epistaxis and petechiae, while treating a COVID-19 patient with ceftriaxone, levofloxacin, and lopinavir/ritonavir. The platelet count decreased to 2,000/mm³ and recovered after discontinuation of the three suspected drugs. In treating a potentially fatal emerging infectious disease, empirical and/or experimental approach would be unavoidable. However, the present case suggests that the possibility of adverse effects caused by polypharmacy should also be carefully considered.


Can COVID-19 virus be transmitted through sex?


Editor in Chief's Introduction to Essays on the Impact of COVID-19 on Work and Workers


title: A virophage cross-species infection through mutant selection represses giant virus propagation, promoting host cell survival

text: Virus adaptation to new hosts is a major cause of infectious disease emergence. This mechanism has been intensively studied in the context of zoonotic virus spillover, due to its impact on global health. However, it remains unclear for virophages, parasites of giant viruses and potential regulators of microbial communities. Here, we present, for the first time to our knowledge, evidence of cross-species infection of a virophage. We demonstrated that challenging the native population of Guarani virophage with two previously unidentified giant viruses, previously nonpermissive to this virophage, allows the selection of a mutant genotype able to infect these giant viruses. We were able to characterize the potential genetic determinant (deletion) carried by the virophage with the expanded-host range. Our study also highlights the relevant biological impact of this host adaptation by demonstrating that coinfection with the mixture containing the mutant virophage abolishes giant virus production and rescues the host cell population from lysis.


title: Declining Public Health Protections within Autocratic Regimes: Impact on Global Public Health Security, Infectious Disease Outbreaks, Epidemics, and Pandemics

text: Public health emergencies of international concern, in the form of infectious disease outbreaks, epidemics, and pandemics, represent an increasing risk to the world's population. Management requires coordinated responses, across many disciplines and nations, and the capacity to muster proper national and global public health education, infrastructure, and prevention measures. Unfortunately, increasing numbers of nations are ruled by autocratic regimes which have characteristically failed to adopt investments in public health infrastructure, education, and prevention measures to keep pace with population growth and density. Autocratic leaders have a direct impact on health security, a direct negative impact on health, and create adverse political and economic conditions that only complicate the crisis further. This is most evident in autocratic regimes where health protections have been seriously and purposely curtailed. All autocratic regimes define public health along economic and political imperatives that are similar across borders and cultures. Autocratic regimes are seriously handicapped by sociopathic narcissistic leaders who are incapable of understanding the health consequences of infectious diseases or the impact on their population. A cross section of autocratic nations currently experiencing the impact of COVID-19 (coronavirus disease 2019) are reviewed to demonstrate the manner where self-serving regimes fail to manage health crises and place the rest of the world at increasing risk. It is time to re-address the pre-SARS (severe acute respiratory syndrome) global agendas calling for stronger strategic capacity, legal authority, support, and institutional status under World Health Organization (WHO) leadership granted by an International Health Regulations Treaty. Treaties remain the most successful means the world has in preventing, preparing for, and controlling epidemics in an increasingly globalized world."Honesty is worth a lot more than hope " The Economist, February 17, 2020.


Could anti-tubercular vaccination protect against COVID-19 infection?


title: COVID-19 and acute pulmonary embolism: what should be considered to indicate a computed tomography pulmonary angiography scan?

text: The full spectrum of COVID-19 is still emerging, although several studies have highlighted that patients infected with the novel coronavirus can potentially develop a hypercoagulable state. However, several aspects related to the incidence and pathophysiology of the association between COVID-19 and pulmonary embolism are not well established. Here, we present a case of a patient with COVID-19 who developed acute pulmonary embolism. Clinical and laboratory data and findings of non-enhanced CT indicate possibility of acute pulmonary embolism, and support the decision to proceed with computed tomography pulmonary angiography that can objectively identify filling defects in pulmonary arterial branches.


docid: nwspruzp

title: Prediction of the SARS-CoV-2 (2019-nCoV) 3C-like protease (3CLpro) structure: virtual screening reveals velpatasvir, ledipasvir, and other drug repurposing candidates [version 1;peer review: 2 approved]

text: We prepared the three-dimensional model of the SARS-CoV-2 (aka 2019-nCoV) 3C-like protease (3CLpro) using the crystal structure of the highly similar (96% identity) ortholog from the SARS-CoV All residues involved in the catalysis, substrate binding and dimerisation are 100% conserved Comparison of the polyprotein PP1AB sequences showed 86% identity The 3C-like cleavage sites on the coronaviral polyproteins are highly conserved Based on the near-identical substrate specificities and high sequence identities, we are of the opinion that some of the previous progress of specific inhibitors development for the SARS-CoV enzyme can be conferred on its SARS-CoV-2 counterpart With the 3CLpro molecular model, we performed virtual screening for purchasable drugs and proposed 16 candidates for consideration Among these, the antivirals ledipasvir or velpatasvir are particularly attractive as therapeutics to combat the new coronavirus with minimal side effects, commonly fatigue and headache The drugs Epclusa (velpatasvir/sofosbuvir) and Harvoni (ledipasvir/sofosbuvir) could be very effective owing to their dual inhibitory actions on two viral enzymes


docid: mwwjroyo

title: Avoiding disruption of timely surgical management of genitourinary cancers during the early phase of COVID-19 pandemic

text: As of early July 2020, over 10,000,000 confirmed SARS-CoV-2 (COVID-19) cases and 500,000 deaths have been recorded worldwide. This dramatic surge of the pandemic resulted in hospital overcrowding and shortage of intensive care unit (ICU) beds, creating a global crisis in health care systems. As many other specialties, Urology was impacted at different levels. A decline in number of elective surgeries was observed, with peaks of over 94% reduction in most affected regions. Outpatient clinics were largely shifted to virtual consults. Interestingly, there was a significant decrease in hospital attendance for urological emergencies. Urologic surgical training was negatively impacted.


Letter in response to letter to the editor by Singh and Dhibar regarding the article "COVID-19: From bench to bedside" (Singh et al.)


Update on COVID-19 effects in dermatology specialty


Avoid stigmatizing names for 2019 novel coronavirus


title: COVID-19 and abortion: The importance of guaranteeing a fundamental right

text: Because of the COVID-19 Pandemic many problems have emerged in the organization of the National Health Systems. In Italy, a very serious problem is emerging which needs a rapid solution. Italian women are finding increasingly difficult to access abortion. These difficulties are related to the organizational changes that have occurred in many hospitals due to the emergency COVID-19. A possible solution would be to resort to the procedure of pharmacological abortion which, however, in Italy, is characterized by many limitations imposed by law. To protect the right to health of all women will need a reorganization of abortion procedures in Italy with implementation of telehealth services.


title: Electroencephalography at the time of Covid-19 pandemic in Italy

text: OBJECTIVE: During the Covid-19 pandemic, government restrictions limited health care to urgent needs. Neurophysiology centers had to suddenly reschedule their activities, with a lack of specific recommendations about electroencephalography (EEG) execution. During the pandemic phase 1, we launched an online survey to understand the flaws and strengths of the EEG management in Italy at the time of Covid-19 pandemic. METHODS: A 45-item online survey (published from April 16 to 30, 2020), endorsed by the Italian Society of Clinical Neurophysiology (SINC), the Italian League Against epilepsy (LICE), and the Italian Association of Neurophysiology technologists (AITN), collected EEG management data (EEG's number and type, indications, personnel and patients safety, devices' sanification) during the Covid-19 pandemic. RESULTS: We received responses from 206 centers. The number of EEGs performed was reduced by 76 ± 20%, and several types of specific EEG (video-EEG, ambulatory-EEG, LTM, polysomnography) were reduced at a minimum. Half of the centers performed inpatient EEGs only for urgencies. Repetitive seizures, encephalitis, and non-convulsive status epilepticus were the most common indications. Covid-19-positive patients received less EEG than negative ones (p < 0.0001). EEG requests came mainly not only from neurologists (n = 176) but also from general practitioners (n = 40), emergentists (n = 79), intensivists (n = 72), and other specialists (n = 53). Those centers which continued performing outpatient EEG examinations were instructed to perform the EEG after a Covid-19-related symptom screening for patients and using personal protective equipment (PPE) through all the procedure. Inpatient EEGs were performed using FFP2/FFP3 masks by neurophysiology technologists in only 50% of cases. Patients executed hyperventilation only for real clinical needs, but often (56%) with a mask. CONCLUSIONS: Italian neurophysiology centers strongly adhered to government restrictions of lockdown. Some issues emerged, ranging from the evaluation of a proper indication for EEG, technical procedures of EEG recording, and protection of neurophysiology technicians.


title: In Silico Investigations on the Potential Inhibitors for COVID-19 Protease

text: A novel strain of coronavirus, namely, COVID-19 has been identified in Wuhan city of China in December 2019. There are no specific therapies available and investigations regarding the treatment of the COVID-19 are still lacking. This prompted us to perform a preliminary in silico study on the COVID-19 protease with anti-malarial compounds in the search of potential inhibitor. We have calculated log P and log S values in addition to molecular docking and PASS predictions. Among the seven studied compounds, mepacrine appears as the potential inhibitor of the COVID-19 followed by chloroquine, hydroxychloroquine and phomarin. Therefore, these anti-malarial drugs may be potential drug candidate for the treatment of this novel coronavirus. A detailed analysis on these inhibitors is currently in progress and clinical studies are invited to investigate their potential medicinal use for the COVID-19.


Death and dying during the pandemic


title: Short-term forecasting of daily COVID-19 cases in Brazil by using the Holt's model

text: INTRODUCTION: We evaluated the performance of the Holt's model to forecast the daily COVID-19 reported cases in Brazil and three Brazilian states. METHODS: We chose the date of the first COVID-19 case to April 25, 2020, as the training period, and April 26 to May 3, 2020, as the test period. RESULTS: The Holt's model performed well in forecasting the cases in Brazil and in São Paulo and Minas Gerais states, but the forecasts were underestimated in Rio de Janeiro state. CONCLUSIONS: The Holt's model can be an adequate short-term forecasting method if their assumptions are adequately verified and validated by experts.


title: Mathematical Modeling of Business Reopening when Facing SARS-CoV-2 Pandemic: Protection, Cost and Risk

text: The sudden onset of the coronavirus (SARS-CoV-2) pandemic has resulted in tremendous loss of human life and economy in more than 210 countries and territories around the world. While self-protections such as wearing mask, sheltering in place and quarantine polices and strategies are necessary for containing virus transmission, tens of millions people in the U.S. have lost their jobs due to the shutdown of businesses. Therefore, how to reopen the economy safely while the virus is still circulating in population has become a problem of significant concern and importance to elected leaders and business executives. In this study, mathematical modeling is employed to quantify the profit generation and the infection risk simultaneously from the point of view of a business entity. Specifically, an ordinary differential equation model was developed to characterize disease transmission and infection risk. An algebraic equation is proposed to determine the net profit that a business entity can generate after reopening and take into account the costs associated of several protection/quarantine guidelines. All model parameters were calibrated based on various data and information sources. Sensitivity analyses and case studies were performed to illustrate the use of the model in practice.


title: SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes

text: OBJECTIVES: To understand SARS-Co-V-2 infection and transmission in UK nursing homes in order to develop preventive strategies for protecting the frail elderly residents. METHODS: An outbreak investigation involving 394 residents and 70 staff, was carried out in 4 nursing homes affected by COVID-19 outbreaks in central London. Two point-prevalence surveys were performed one week apart where residents underwent SARS-CoV-2 testing and had relevant symptoms documented. Asymptomatic staff from three of the four homes were also offered SARS-CoV-2 testing. RESULTS: Overall, 26% (95% CI 22-31) of residents died over the two-month period. All-cause mortality increased by 203% (95% CI 70-336) compared with previous years. Systematic testing identified 40% (95% CI 35-46) of residents as positive for SARS-CoV-2, and of these 43% (95% CI 34-52) were asymptomatic and 18% (95% CI 11-24) had only atypical symptoms; 4% (95% CI -1 to 9) of asymptomatic staff also tested positive. CONCLUSIONS: The SARS-CoV-2 outbreak in four UK nursing homes was associated with very high infection and mortality rates. Many residents developed either atypical or had no discernible symptoms. A number of asymptomatic staff members also tested positive, suggesting a role for regular screening of both residents and staff in mitigating future outbreaks.


title: Managing Cutaneous Immune-Mediated Diseases During the COVID-19 Pandemic

text: Coronavirus disease 2019 (COVID-19) is a clinical syndrome caused by a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has spread rapidly worldwide and has been shown to have a wide spectrum of severity. COVID-19 has become a public health emergency of relevant international concern, and it was declared a pandemic by the World Health Organization on 11 March, 2020. SARS-CoV-2 infection in severe cases involves the host response as an important contributor to the disease process and tissue damage, mainly due to dysregulated and excessive innate immune responses. The primary immune response leads to viral clearance in the majority of cases. However, in a subgroup of patients, the secondary immune response may be exaggerated, leading to inflammatory-induced lung injury and other complications including pneumonitis, acute respiratory distress syndrome, respiratory failure, shock, organ failure, and potentially death. Several cutaneous immune-mediated diseases, including psoriasis, atopic dermatitis, and hidradenitis suppurativa, are therapeutically managed with biologic and non-biologic immunosuppressive and immunomodulatory drugs. The outbreak of COVID-19 affects the management of these chronic conditions, not only for those who are already receiving treatment but also for those who are about to start a new treatment to control their disease. In this article, the management of cutaneous immune-mediated diseases during the COVID-19 pandemic is discussed.


title: Effect of pain on mood affective disorders in adults with cerebral palsy

text: AIM: To determine if pain is associated with 12-month incidence of mood affective disorders (MAD) in adults with cerebral palsy (CP). METHOD: Data from Optum Clinformatics® Data Mart (2013-2016) were used for this retrospective cohort study. Diagnostic codes were used to identify adults (≥18y) with CP, incident cases of MAD, and covariates (other neurodevelopmental conditions, sleep disorders, arthritis). Pain (any type, location) was identified between 1st October 2014 and 30th September 2015. The pain group was divided into new or consistent pain if they had a history of pain (i.e. consistent) in the 12 months before their first pain claim date. Crude incidence rates of MAD (expressed per 100 person-years) were estimated. Cox regression was used to estimate hazard ratio (95% confidence interval [CI]) of MAD after adjusting for covariates. RESULTS: Adults that had new pain (n=859; incidence rate=15.5) or consistent pain (n=1303; incidence rate=17.9) had greater crude incidence rate of MAD compared to adults without pain (n=3726; incidence rate=5.9). The elevated rate of MAD remained after adjusting for covariates, for new pain (hazard ratio=2.4; 95% CI=1.9-3.0) and consistent pain (hazard ratio=2.1; 95% CI=1.7-2.7). INTERPRETATION: Pain is associated with greater incidence of MAD in adults with CP. This association remained after accounting for potential confounding factors. WHAT THIS PAPER ADDS: What this paper adds Pain was associated with higher 12-month incidence of mood affective disorders (MAD). The 12-month MAD incidence was similar between new and consistent pain groups. The MAD incidence remained higher adjusting for neurodevelopmental comorbidities, sleep disorders, and arthritis.


docid: jxutbxso

title: The Imperfect Cytokine Storm: Severe COVID-19 with ARDS in Patient on Durable LVAD Support

text: As health systems worldwide grapple with the COVID-19 pandemic, patients on durable LVAD support represent a unique population at risk for the disease. We outline such a patient who developed COVID-19 complicated by "cytokine storm" with severe ARDS and myocardial injury; and describe the challenges that arose during management.


In Reference to Anosmia and Ageusia: Common Findings in COVID-19 Patients


Surgical resection for liver cancer during the COVID-19 outbreak


title: Alternative Care Sites: An Option in Disasters

text: During the current COVID-19 pandemic, the limited surge capacity of the healthcare system is being quickly overwhelmed. Similar scenarios play out when an institution's systems fail, or when local or regional disasters occur. In these situations, it becomes necessary to use one or more alternative care sites (ACS). Situated in a variety of non-healthcare structures, ACS may be used for ambulatory, acute, subacute, or chronic care. Developing alternative care facilities is the disaster-planning step that moves communities from talking to doing. This commitment pays real dividends if a disaster of any magnitude strikes. This paper discusses the basic criteria for selecting, establishing and ultimately closing an ACS, difficulties of administration, staffing, security, and providing basic supplies and equipment.


Schamberg-like purpuric eruptions and tonsillitis in mild COVID-19


title: Umgang mit COVID-19 in der Notaufnahme : Erfahrungsbericht der interdisziplinären Notaufnahme des Universitätsklinikums Münster./ [Handling of COVID-19 in the emergency department : Field report of the emergency ward of the University Hospital Münster]

text: With the COVID-19 pandemic, emergency rooms are faced with major challenges because they act as the interface between outpatient and inpatient care. The dynamics of the pandemic forced emergency care at the University Hospital Münster to extensively adjust their processes, which had to be carried out in the shortest time possible. This included the establishment of an outpatient coronavirus test center and a medical student-operated telephone hotline. Inside the hospital, new isolation capacities in the emergency room and a dedicated COVID-19 ward were set up. The patient flow was reorganized using flow diagrams for both the outpatient and inpatient areas. The general and special emergency management was optimized for the efficient treatment of COVID-19-positive patients and the staff were trained in the use of protective equipment. This report of our experience is intended to support other emergency departments in their preparation for the COVID-19 pandemic.


title: Critically-ill COVID-19 patient

text: Coronavirus disease 2019 (COVID-19) stands out as the major pandemic that we have experienced in the last century. As it affects every social structure, it brought the importance of intensive care support once again to the agenda of healthcare system after causing severe acute respiratory syndrome. The precautions to be taken against this virus, where our knowledge is extremely small, intensive care units take an indispensable place in pandemic planning. In this review, we aimed to emphasize the crucial points regarding intensive care management of COVID-19 patients, which we have written not only for intensivists but also for all healthcare professionals.


Regarding "Artificial Intelligence Distinguishes COVID-19 from Community Acquired Pneumonia on Chest CT"


Health resort medicine can be a suitable setting to recover disabilities in patients tested negative for COVID-19 discharged from hospital? A challenge for the future


Targeting the interleukin-17 pathway to prevent acute respiratory distress syndrome associated with SARS-CoV-2 infection


Ghrelin Reduces A-Type Potassium Currents in Dopaminergic Nigral Neurons via the PLC/PKCÎ´ Pathway


Covid-19: Deprived areas have the highest death rates in England and Wales


title: Delayed prefrontal hemodynamic response associated with suicide risk in autism spectrum disorder

text: Adults diagnosed with Autism spectrum disorder (ASD) are at high risk of experiencing suicidality compared with other clinical groups. Recently, near-infrared spectroscopy (NIRS) studies have investigated the association between frontotemporal functional abnormalities and suicidality in patients with mood disorders. However, whether these prefrontal hemodynamic responses are associated with suicide vulnerability in individuals with ASD remains unclear. Here, we used 24-channel NIRS to examine the characteristics of prefrontal hemodynamic responses during a verbal fluency task in 20 adults with ASD and in age-, sex-, and intelligence quotient-matched healthy controls. In addition, we used Spearman's correlation analysis to identify the relationship between the time-course of prefrontal hemodynamic activation and the current suicide risk in patients with ASD. We found no significant differences between the verbal fluency task-induced prefrontal hemodynamic responses in the ASD vs. control group. However, we found a significant positive correlation between the current suicide risk score and the time-course of prefrontal hemodynamic activation in the ASD group. Thus, the 24-channel NIRS system appears to be useful in assessing suicide risk in individuals with ASD.


title: Flexible Laryngoscopy and COVID-19

text: Flexible laryngoscopy, the gold-standard evaluation of the larynx and the pharynx, is one of the most commonly performed procedures in otolaryngology. During the coronavirus disease 2019 (COVID-19) pandemic, flexible laryngoscopy represents a risk for patients and an occupational hazard for otolaryngologists and any clinic staff involved with the procedure or endoscope reprocessing. Here we present a set of recommendations on flexible laryngoscopy performance during the pandemic, including patient selection, personal protective equipment, and endoscope disinfection, based on a consensus reached during a virtual webinar on March 24, 2020, attended by approximately 300 participants from the American laryngology community.


Telehealth visits in a tertiary cardiovascular centre as a response of the healthcare system to the pandemic of SARS-CoV-2 in Poland


title: Tunisian Recommendations for resumption of Reproductive Medicine activity in the Covid-19 pandemic

text: The activity of the Reproductive Medicine poses a dilemma in this pandemic Covid-19. In fact, this is a theoretically non-emergency activity except for fertility preservation with oncological reasons. The majority of fertility societies in the world such as the American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) recommended stopping the inclusion of new patients and continuing only the In Vitro Fertilization (IVF) cycles that have already been initiated by promoting Freeze-all as much as possible. Initilaly, the "Société Tunisienne de Gynécologie Obstétrique" (STGO) issued national recommendations that echo the international recommendations. These recommendations were followed by the majority of IVF center in Tunisia. However, a number of new data are prompting us to update these recommendations.


Oral vesiculobullous lesions associated with SARS-CoV-2 infection


Covid-19: ibuprofen can be used for symptoms, says UK agency, but reasons for change in advice are unclear


title: Protocol and Reagents for Pseudotyping Lentiviral Particles with SARS-CoV-2 Spike Protein for Neutralization Assays

text: SARS-CoV-2 enters cells using its Spike protein, which is also the main target of neutralizing antibodies. Therefore, assays to measure how antibodies and sera affect Spike-mediated viral infection are important for studying immunity. Because SARS-CoV-2 is a biosafety-level-3 virus, one way to simplify such assays is to pseudotype biosafety-level-2 viral particles with Spike. Such pseudotyping has now been described for single-cycle lentiviral, retroviral, and vesicular stomatitis virus (VSV) particles, but the reagents and protocols are not widely available. Here, we detailed how to effectively pseudotype lentiviral particles with SARS-CoV-2 Spike and infect 293T cells engineered to express the SARS-CoV-2 receptor, ACE2. We also made all the key experimental reagents available in the BEI Resources repository of ATCC and the NIH. Furthermore, we demonstrated how these pseudotyped lentiviral particles could be used to measure the neutralizing activity of human sera or plasma against SARS-CoV-2 in convenient luciferase-based assays, thereby providing a valuable complement to ELISA-based methods that measure antibody binding rather than neutralization.


title: How villagers in central Sierra Leone understand infection risks under threat of Covid-19

text: BACKGROUND: Concern has been expressed over how well Africa is prepared to cope with the pandemic of Covid-19. Will rural populations with low levels of education know how to apply community-based infection control? We undertook fieldwork in two villages in central Sierra Leone to gain insight into how rural people faced with Covid-19 assess epidemic infection risks. METHODS: Two communities were selected based on prior contrasted exposure to Ebola Virus Disease-one with substantial number of cases and the other having resisted infection through strong community sequestration measures. We assessed understanding of infection risks via an experimental game. This asked players to express a preference for one of two diseases, one resembling Ebola with lower risk of infection and the other resembling Covid-19 with lower risk of death. Players were not told the identity of the diseases. RESULTS: In total 107 adult villagers played the game (58% women). Half (52%) preferred the disease model with lower risk of infection, 29% preferred the model with lower risk of death, while 21% saw the combined risk of infection and death as being equivalent. Differences in reactions between the two locations were small despite different experiences of Ebola. Asked to explain their choices 48% of players cited information on infection risks modelled by the game and 31% stated that their choices reflected awareness of the need for personal action and respect for local regulations. We concluded that villagers thoughtfully assess disease risks and that some are good intuitive statisticians. CONCLUSIONS: Results suggest rural people in Sierra Leone retain the lessons of experience from the Ebola outbreak of 2014-15 and will be able to apply these lessons to a new infectious disease for which have no prior practical experience. Our expectation is that rural populations will understand Covid-19 control measures, thus reducing need for draconian enforcement.


title: Clinical and economic strategies in outpatient medical care during the COVID-19 pandemic

text: The COVID-19 pandemic has resulted in significant clinical and economic consequences for medical practices of all specialties across the nation. Although the clinical implications are of the utmost importance, the economic consequences have also been serious and resulted in substantial damage to the US healthcare system, including pain practices. Outpatient pain practices have had to significantly change their clinical care pathways, including the incorporation of telemedicine. Elective medical and interventional care has been postponed. For the most part, ambulatory surgical centers have had to cease operations. As patient volumes have decreased for non-emergent elective care, the financial indicators have deteriorated. This review article will provide insight into solutions to mitigate the clinical and economic challenges induced by COVID-19. Undoubtedly, the COVID-19 pandemic will have short-term and long-term implications for all medical practices and facilities. In order to survive, medical practices will need dynamic, operational, and creative strategic plans to mitigate the disruption in medical care and pathways for successful reintegration of clinical and surgical practice.


title: Nursing Continuing Professional Development-A Paradigm Shift

text: The COVID-19 pandemic has created the need for rapid development and implementation of nursing continuing professional development (NCPD) to scale up nurses and other health care providers to meet a surge in critically ill patients. Through retooling and upskilling nurses and other health care providers, professional development is more important now than ever before. A heightened need for flexible professional development activity planning that is fully integrated into the professional environment is integral to prepare nurses to meet the challenges posed by this pandemic. This article addresses strategies to facilitate delivery of quality NCPD educational activities in real time. [J Contin Educ Nurs. 2020;51(7):297-299.].


title: Economic, Mental Health, HIV Prevention and HIV Treatment Impacts of COVID-19 and the COVID-19 Response on a Global Sample of Cisgender Gay Men and Other Men Who Have Sex with Men

text: There is an urgent need to measure the impacts of COVID-19 among gay men and other men who have sex with men (MSM). We conducted a cross-sectional survey with a global sample of gay men and other MSM (n = 2732) from April 16, 2020 to May 4, 2020, through a social networking app. We characterized the economic, mental health, HIV prevention and HIV treatment impacts of COVID-19 and the COVID-19 response, and examined whether sub-groups of our study population are disproportionately impacted by COVID-19. Many gay men and other MSM not only reported economic and mental health consequences, but also interruptions to HIV prevention and testing, and HIV care and treatment services. These consequences were significantly greater among people living with HIV, racial/ethnic minorities, immigrants, sex workers, and socio-economically disadvantaged groups. These findings highlight the urgent need to mitigate the negative impacts of COVID-19 among gay men and other MSM.


ERAS protocols in gynecologic oncology during COVID-19 pandemic


Covid-19: Hospitals can remove 15% cap on testing of NHS staff


Reply to: "Personal protective equipment recommendations based on COVID-19 route of transmission"


title: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Emergence, History, Basic and Clinical Aspects

text: In late December 2019, the world woke to a reality of a pandemic of Coronavirus Disease (COVID-19), elicited by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which belongs to a group of ß-coronavirus. The potential to cause life-threatening respiratory failure and rapid transmission puts COVID-19 in the list of Public Health Emergency of International Concern (PHEIC). In the last two decades, this is the 3rd deadliest Coronavirus pandemic, following SARS which lasted between 2002 and 2003 and Middle East Respiratory Syndrome (MERS) from 2012 till date. Globally and as of April 1st 2020, COVID-19 has affected 924,688 individuals in over 200 countries, causing 46,368 fatalities. While the SARS-CoV-2 originated in China with over 82,724 confirmed cases and more than 3000 deaths as at the time of writing this review, the rapid transmission of SARS-CoV-2 has resulted in exponential increase in the number of cases outside of China to about 10 times the report case and death in mainland China. SARS-CoV-2 is suspected to be zoonotic in nature as genetic studies have shown sequence similarity to viruses originating from bats. Extreme precautionary measures, such as curfew, shutting of borders and quarantining of individuals suspected to be infected have been instituted with immediate effect; however, due to individuals that are asymptomatic, uncontrolled human-to-human transmission has resulted in exponential infection rate and numerous loss of lives even with this lockdown measures. This review article summarizes the developing situation surrounding the SARS-CoV-2 pandemic with respect to its epidemiology, unique genomic structure, possible origins, transmission, pathogenesis, comparison with other deadly species of Coronaviruses (CoV) and emerging treatment strategies built on informed literature.


docid: eztcgeva

title: Lopinavir/ritonavir as a third agent in the antiviral regimen for SARS-CoV-2 infection

text: Corona Virus Disease (CoVID-19) is an emerging public health problem rapidly spread globally. New treatment options for patients with severe symptoms and ways of reducing transmission in the community are taken into consideration. A retrospective study was conducted in the Department of Infectious Diseases of Alexandroupolis (Greece) including 16 patients with CoVID-19. They were classified into two groups, A and B. Group A received lopinavir/ritonavir as a third agent in the antiviral regimen, while group B did not. Lymphocytes were more significantly increased in patients of group A. Ferritin serum levels were also decreased significantly in these patients. Number of days needed for a first negative result of Real Time- Polymerase Chain Reaction (RT-PCR) was lower for Group A. The present study suggests that lopinavir/ritonavir may reduce the viral carriage in a shorter period of time compared with other antiviral regimens. Further studies are needed in order to evaluate the effectiveness of lopinavir/ritonavir in the treatment of patients with SARS-CoV-2 infection.


title: Immune modulation in COVID-19: Strategic considerations for personalized therapeutic intervention

text: We are learning that the host response to SARS-CoV-2 infection is complex and highly dynamic. Effective initial host defense in the lung is associated with mild symptoms and disease resolution. Viral evasion of the immune response can lead to refractory alveolar damage, ineffective lung repair mechanisms, and systemic inflammation with associated organ dysfunction. The immune response in these patients is highly variable and can include moderate to severe systemic inflammation and/or marked systemic immune suppression. There is unlikely to be a "one size fits all" approach to immunomodulation in patients with COVID-19. We believe that a personalized, immunophenotype-driven approach to immunomodulation that may include anti-cytokine therapy in carefully selected patients and immunostimulatory therapies in others is the shortest path to success in the study and treatment of patients with critical illness due to COVID-19.


Use of herbal drugs to treat COVID-19 should be with caution


title: Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19

text: Background & objectives: Healthcare workers (HCWs) are at an elevated risk of contracting COVID-19. While intense occupational exposure associated with aerosol-generating procedures underlines the necessity of using personal protective equipment (PPE) by HCWs, high-transmission efficiency of the causative agent [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] could also lead to infections beyond such settings. Hydroxychloroquine (HCQ), a repurposed antimalarial drug, was empirically recommended as prophylaxis by the National COVID-19 Task Force in India to cover such added risk. Against this background, the current investigation was carried out to identify the factors associated with SARS-CoV-2 infection among HCWs in the country. Methods: A case-control design was adopted and participants were randomly drawn from the countrywide COVID-19 testing data portal maintained by the ICMR. The test results and contact details of HCWs, diagnosed as positive (cases) or negative (controls) for SARS-CoV-2 using real-time reverse transcription-polymerase chain reaction (qRT-PCR), were available from this database. A 20-item brief-questionnaire elicited information on place of work, procedures conducted and use of PPE. Results: Compared to controls, cases were slightly older (34.7 vs. 33.5 yr) and had more males (58 vs. 50%). In multivariate analyses, HCWs performing endotracheal intubation had higher odds of being SARS-CoV-2 infected [adjusted odds ratio (AOR): 4.33, 95% confidence interval (CI): 1.16-16.07]. Consumption of four or more maintenance doses of HCQ was associated with a significant decline in the odds of getting infected (AOR: 0.44; 95% CI: 0.22-0.88); a dose-response relationship existed between frequency of exposure to HCQ and such reductions (χ[2] for trend=48.88; P <0.001). In addition, the use of PPE was independently associated with the reduction in odds of getting infected with SARS-CoV-2. Interpretations & conclusions: Until results of clinical trials for HCQ prophylaxis become available, this study provides actionable information for policymakers to protect HCWs at the forefront of COVID-19 response. The public health message of sustained intake of HCQ prophylaxis as well as appropriate PPE use need to be considered in conjunction with risk homoeostasis operating at individual levels.


title: Cohesion in Distancing

text: In isolation, we are physically apart; in solidarity, we are together. The COVID-19 pandemic emphasizes our social responsibility to maintain physical distance from one another. In doing so, we solidify our collective strength.


Inuit communities can beat COVID-19 and tuberculosis


Diffuse Myocardial Inflammation in COVID-19 Associated Myocarditis Detected by Multiparametric Cardiac Magnetic Resonance Imaging


An Italian paediatric department at the time of Coronavirus: a resident's point of view


title: Disproportionate burden of COVID-19 among racial minorities and those in congregate settings among a large cohort of people with HIV

text: BACKGROUND: Many people living with HIV (PLWH) have comorbidities which are risk factors for severe COVID-19 or have exposures that may lead to acquisition of SARS-CoV-2. There are few studies, however, on the demographics, comorbidities, clinical presentation or outcomes of COVID-19 in people with HIV. OBJECTIVE: To evaluate risk factors, clinical manifestations and outcomes in a large cohort of PLWH with COVID-19. METHODS: We systematically identified all PLWH who were diagnosed with COVID-19 at a large hospital from March 3 to April 26, 2020 during an outbreak in Massachusetts. We analyzed each of the cases to extract information including demographics, medical comorbidities, clinical presentation, and illness course after COVID-19 diagnosis. RESULTS: We describe a cohort of 36 PLWH with confirmed COVID-19 and another 11 patients with probable COVID-19. Almost 85% of PLWH with confirmed COVID-19 had a comorbidity associated with severe disease, including obesity, cardiovascular disease, or hypertension. Approximately 77% of PLWH with COVID-19 were non-Hispanic Black or Latinx whereas only 40% of the PLWH in our clinic were Black or Latinx. Nearly half of PLWH with COVID-19 had exposure to congregate settings. In addition to people with confirmed COVID-19, we identified another 11 individuals with probable COVID-19, almost all of whom had negative PCR testing. CONCLUSION: In the largest cohort to date of PLWH and confirmed COVID-19, almost all had a comorbidity associated with severe disease, highlighting the importance of non-HIV risk factors in this population. The racial disparities and frequent link to congregate settings in PLWH and COVID-19 need to be explored urgently.


Thoracic Computed Tomography Features of Coronavirus Disease 2019 Patients with Emphysema


title: Fladdermöss och människor./ [Bats and humans]

text: Coronavirus (CoV) species are very common among animals, especially bats. The last two decades three large CoV outbreaks have appeared among humans; Severe Adult Respiratory Syndrome (SARS-1) in 2003, Middle East Respiratory Syndrome (MERS) in 2012 and SARS-2 in 2019, (COVID19). Also a large epidemic among swine, Swine Acute Diarrhea Syndrome (SADS) appeared in 2017 in China. There is a pool of coronavirus among bats which have the potential to infect humans through the ACE2 receptor, and new human epidemics can be expected. Therefore it is of great importance to develop new antivirals and vaccines against CoV as well as to improve the global infectious disease control of these infections.


Publication of COVID-19 case reports: Are we hurrying?


Drugs being investigated for children with COVID-19


Is the oncologic patient more susceptible to covid19 but perhaps less likely to undergo severe infection-related complications due to fewer cytokines storm as a consequent of the associated immunodeficiency?


title: Influenza and COVID-19 coinfection: Report of six cases and review of the literature

text: Coronavirus disease 2019 (COVID-19) pandemic caused infection in a season when influenza is still prevalent. Both viruses have similar transmission characteristics and common clinical manifestations. Influenza has been described to cause respiratory infection with some other respiratory pathogens. However, the information of COVID-19 and influenza coinfection is limited. In this study, we reported our coinfected cases and reviewed the literature. We included all COVID-19 diagnosed patients. All patients with a presumed diagnosis of COVID-19 were routinely screened for influenza. Their thorax radiology was reviewed for COVID-19-influenza differentiation. During the study period, 1103 patients have been diagnosed with COVID-19. Among them, six patients (0.54%) were diagnosed coinfected with influenza. There have been 28 more coinfected patients reported. Laboratory-based screening studies reported more patients. Thorax radiology findings were compatible with COVID-19 in five and with influenza in one of our patients. Our cases were mild to moderate in severity. The reported cases in the literature included patients died (n = 2) and those living ventilator dependent or under mechanical ventilation. COVID-19 and influenza coinfection is rare. Screening studies report more cases, suggesting that unless screening patients with COVID-19, the coinfection remains undiagnosed and underestimated. Increasing experience in thoracic radiology may contribute to diagnose the responsible virus(es) from the clinical illness. Influenza vaccine for larger population groups can be recommended to simplify clinicians' work.


title: Dysregulation of immune response in patients with COVID-19 in Wuhan, China ;Clinical Infectious Diseases ;Oxford Academic

text: Abstract Background In December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread throughout China Methods Demographic and clinical data of all confirmed cases with COVID-19 on admission at Tongji Hospital from January 10 to February 12, 2020, were collected and analyzed The data of laboratory examinations, including peripheral lymphocyte subsets, were analyzed and compared between severe and non-severe patients Results Of the 452 patients with COVID-19 recruited, 286 were diagnosed as severe infection The median age was 58 years and 235 were male The most common symptoms were fever, shortness of breath, expectoration, fatigue, dry cough and myalgia Severe cases tend to have lower lymphocytes counts, higher leukocytes counts and neutrophil-lymphocyte-ratio (NLR), as well as lower percentages of monocytes, eosinophils, and basophils Most of severe cases demonstrated elevated levels of infection-related biomarkers and inflammatory cytokines The number of T cells significantly decreased, and more hampered in severe cases Both helper T cells and suppressor T cells in patients with COVID-19 were below normal levels, and lower level of helper T cells in severe group The percentage of naïve helper T cells increased and memory helper T cells decreased in severe cases Patients with COVID-19 also have lower level of regulatory T cells, and more obviously damaged in severe cases Conclusions The novel coronavirus might mainly act on lymphocytes, especially T lymphocytes Surveillance of NLR and lymphocyte subsets is helpful in the early screening of critical illness, diagnosis and treatment of COVID-19


title: Dysregulation of immune response in patients with COVID-19 in Wuhan, China

text: BACKGROUND: In December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread throughout China. METHODS: Demographic and clinical data of all confirmed cases with COVID-19 on admission at Tongji Hospital from January 10 to February 12, 2020, were collected and analyzed. The data of laboratory examinations, including peripheral lymphocyte subsets, were analyzed and compared between severe and non-severe patients. RESULTS: Of the 452 patients with COVID-19 recruited, 286 were diagnosed as severe infection. The median age was 58 years and 235 were male. The most common symptoms were fever, shortness of breath, expectoration, fatigue, dry cough and myalgia. Severe cases tend to have lower lymphocytes counts, higher leukocytes counts and neutrophil-lymphocyte-ratio (NLR), as well as lower percentages of monocytes, eosinophils, and basophils. Most of severe cases demonstrated elevated levels of infection-related biomarkers and inflammatory cytokines. The number of T cells significantly decreased, and more hampered in severe cases. Both helper T cells and suppressor T cells in patients with COVID-19 were below normal levels, and lower level of helper T cells in severe group. The percentage of naïve helper T cells increased and memory helper T cells decreased in severe cases. Patients with COVID-19 also have lower level of regulatory T cells, and more obviously damaged in severe cases. CONCLUSIONS: The novel coronavirus might mainly act on lymphocytes, especially T lymphocytes. Surveillance of NLR and lymphocyte subsets is helpful in the early screening of critical illness, diagnosis and treatment of COVID-19.


title: Modulation of Hb-O2 affinity to improve hypoxemia in COVID-19 patients

text: This opinion paper aims at discussing the potential impact of modulating the Hb-O2 affinity by the nutritional supplement 5-HMF on patients affected by COVID-19. The paper describes the critical role of the oxygen affinity in hypoxemic COVID-19 patients and the potential positive effect of 5-HMF, a compound shown to increase the Hb-O2 affinity.


Management of Critically Ill Adults With COVID-19


Letter: Neurosurgical Patients' Management During the COVID-19 Pandemic-An Institutional Report From an African Neurosurgical Center


title: Proposing a fungal metabolite-Flaviolin as a potential inhibitor of 3CLpro of novel coronavirus SARS-CoV2 using docking and molecular dynamics

text: Here after performing docking and molecular dynamics of various small molecules derived as a secondary metabolite from fungi, we propose Flaviolin to act as potent inhibitor of 3-chymotrypsin (3C) like protease (3CLpro) of noval corona virus SARS-CoV2 responsible for pandemic condition caused by coronavirus disease 2019 (COVID-19).


Images in Clinical ECT: Immediate impact of COVID-19 on ECT Practice


title: When Public Health Crises Collide: Social Disparities and COVID-19

text: In To Have or to Be?, psychoanalyst Erich Fromm writes about pursuit after domination of nature, material abundance, and unlimited happiness, which made modern society become more interested in having than in being. Income, in his view, should not be as accentuated as to create different experiences of life for different groups [1]. Of the concepts that Fromm presents, the domination of nature, which facilitates zoonotic spillover events by increasing the overlap between the habitat of various species with that of humans [2-5], and the gap between the rich and the poor, which recently has become the widest in years [6], become particularly relevant in context of the COVID-19 pandemic.


Telemedicine and COVID-19: an Observational Study of Rapid Scale Up in a US Academic Medical System


title: Allelopathic bioactivity of fresh and infused aqueous extracts of Brazilian cherry (Eugenia uniflora L. ) on lettuce and maize/ Bioatividade alelopática de extrato aquoso fresco e infuso de pitangueira (Eugenia uniflora L. ) sobre alface e milho

text: This study aimed to analyse the allelopathic bioactivity of fresh and infused aqueous extracts of Brazilian cherry leaves on the germination of lettuce and the initial development of maize. Brazilian cherry leaves were used to prepare a fresh aqueous extract (200 g L-1) and an infused extract (100 g L-1), which were diluted to concentrations of 0.4, 0.8, 1.2, 1.6 or 2.0% w/v. The variables evaluated in lettuce were the germination rate (GR), germination time index (GTI), germination speed index (GSI) and root length (RL). To determine the effect on the initial development of maize, we measured the shoot (SL) and root (RL) length. The experimental design included a factorial 2 × 5 design (two extracts and five concentrations), in addition to a control treatment (no extract). In general, the allelopathic bioactivity differed between the fresh and infused extracts. The fresh extract was more phytotoxic for the GR and RL of lettuce. Some beneficial results were observed for the infused extract, including an increase in the RL of lettuce and SL of maize. These effects were dependent on the extract concentration. Thus, there is evidence that Brazilian cherry extracts have allelopathic bioactivity.(AU)


title: Cardiac Rehabilitation during the COVID-19 Era: Guidance on Implementing Virtual Care

text: Cardiac rehabilitation programs across Canada have suspended in-person services as a result of large-scale physical distancing recommendations designed to flatten the COVID-19 pandemic curve. Virtual cardiac rehabilitation (VCR) offers an alternate mechanism of care delivery, capable of providing similar patient outcomes and safety profiles compared to centre-based programs. In order to minimize care gaps, all centres should consider developing and implementing a VCR program. The process of this rapid implementation however can be daunting. Centres should initially focus on the collation, utilization and re-purposing of existing resources, equipment, and technology. Once established, programs should then focus on ensuring that quality indicators are met and care processes are protocolized. This should be followed by the development of sustainable VCR solutions to account for care gaps that existed prior to COVID-19, and to improve cardiac rehabilitation delivery moving forward. This article reviews the potential challenges and obstacles of this process and aims to provide pragmatic guidance to aid clinicians and administrators during this challenging time.


Response to "Dose Rationale for Favipiravir Use in Patients Infected With SARS-CoV-2"


title: Impact of COVID-19 on the mental health of surgeons and coping strategies

text: Unprecedented times call for extraordinary measures. While surgeons across the globe try to comprehend the evolving facade of the COVID-19 pandemic and improvise surgical practice to the best of their ability, the psychological impact of the stress on their own mental health and well-being has been underestimated. This paper aims to review the indirect and overt factors that may affect the mental health of a surgeon in the present circumstances. Furthermore, it will aim to highlight key coping mechanisms at an individual and institutional level, so as to mitigate the negative psychological impact on surgeons.


Guide to Understanding the 2019 Novel Coronavirus


Letter to the Editor "Effects of Coronavirus Disease 2019 (COVID-19) Pandemic on Neurological Surgery Care and Education; Our Experience from Iran"


SWAB team instead of SWAT team: Medical students as a frontline force during the COVID-19 pandemic


COVID-19 in gastroenterology and hepatology: Living with the realities of a historic 21st century pandemic


Safeguarding Dermatologist Attendings and Residents Amid the COVID-19 Pandemic: Focus on Special Populations


Safeguarding dermatologist attendings and residents amid the COVID-19 pandemic: Focus on special populations


title: Belatacept, kidney transplantation and COVID-19: successful management of the first reported case within the United Kingdom

text: Kidney transplant recipients may be at particular risk of acquiring SARS-CoV-2 infection with poor outcomes.1 In a recent case report 2 it was hypothesised that kidney transplant recipients on maintenance belatacept, a cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) fusion protein, have a milder disease course due to belatacept mitigating the cytokine storm and resultant acute respiratory distress syndrome which have been linked to severity of COVID-19. 3 Here we present the first reported case in the United Kingdom of a kidney transplant patient on belatacept who on the contrary developed a severe COVID-19 pneumonia requiring intensive care admission and intubation.


Coronavirus Disease 19 Pandemic and Extracorporeal Therapies in Intensive Care: "Bis Peccare in Bello Non Licet"


title: Cash, cash conversion cycle, inventory and covid-19

text: In recent years, hospital cash balances and cash conversion has been largely stable in Washington State hospitals, with the only increase coming in terms of increasing inventory At current levels, cash is in short supply at many hospitals While increasing inventory would appear to be a good move in light of the COVID-19 pandemic, inventory is not a single generic item Hospital inventory is comprised of literally thousands of supplies and medications, only a few of which are critical Hospital financial viability could be threatened by insufficient liquidity


Call to Action: Announcing the Traditional, Complementary and Integrative Health and Medicine COVID-19 Support Registry


title: On Fast Multi-Shot COVID-19 Interventions for Post Lock-Down Mitigation

text: Fast intermittent lock-down intervals with regular period are suggested as a COVID-19 exit strategy from the widely adopted policy of total lock-down. Many proposed exit strategies have risks and uncertainties which could lead to a second wave of infection [1,2]. We demonstrate that our proposed policies have the potential to be a method of virus suppression, while at the same time allowing continued (albeit reduced) economic activity. Furthermore, these policies, while not eliminating the virus, can nevertheless be sustained over long periods of time, until a vaccine or treatment becomes available. The robustness of these policies stems from the fact that they are open loop methods; namely, lock-down periods are not triggered by measurements -- inevitably uncertain and delayed -- over short time scales such as hospital admissions, but rather are driven by predictable, high-frequency, periodic triggers in- and out- of lock-down. A slow and inherently robust outer supervisory feedback loop, based on measurements over longer time scales, is used to tune the parameters of the mitigation strategy. These methods can act alone, or can be used in combination with other mitigation strategies, to provide additional levels of effectiveness in their operation.


Erratum zu: Erhöhtes Risiko für tiefe Beinvenenthrombosen bei Intensivpatienten mit CoViD-19-Infektion?  Erste Daten./ [Erratum to: Increased risk of deep vein thrombosis in intensive care unit patients with CoViD-19 infections?-Preliminary data]


title: Safety at the Time of the COVID-19 Pandemic: How to Keep our Oncology Patients and Healthcare Workers Safe

text: The novel coronavirus, SARS-CoV-2, was first detected as a respiratory illness in December 2019 in Wuhan City, China. Since then, coronavirus disease 2019 (COVID-19) has impacted every aspect of our lives worldwide. In a time when terms such as social distancing and flattening the curve have become a part of our vernacular, it is essential that we understand what measures can be implemented to protect our patients and healthcare workers. Undoubtedly, healthcare providers have had to rapidly alter care delivery models while simultaneously acknowledging the crucial unknowns of how these changes may affect clinical outcomes. This special feature reviews strategies on how to mitigate transmission of COVID-19 in an effort to reduce morbidity and mortality associated with the disease for patients with cancer without infection, for patients with cancer with COVID-19 infection, and for the healthcare workers caring for them, while continuing to provide the best possible cancer care. [Editor's Note: This article includes the most current information available at time of publication; however, recommendations regarding public safety and practice may change rapidly in this situation. Individuals should get the most up to date information from the CDC website.].


Secondary attack rate and superspreading events for SARS-CoV-2


title: Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry

text: OBJECTIVES: COVID-19 outcomes in people with rheumatic diseases remain poorly understood. The aim was to examine demographic and clinical factors associated with COVID-19 hospitalisation status in people with rheumatic disease. METHODS: Case series of individuals with rheumatic disease and COVID-19 from the COVID-19 Global Rheumatology Alliance registry: 24 March 2020 to 20 April 2020. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Age, sex, smoking status, rheumatic disease diagnosis, comorbidities and rheumatic disease medications taken immediately prior to infection were analysed. RESULTS: A total of 600 cases from 40 countries were included. Nearly half of the cases were hospitalised (277, 46%) and 55 (9%) died. In multivariable-adjusted models, prednisone dose ≥10 mg/day was associated with higher odds of hospitalisation (OR 2.05, 95% CI 1.06 to 3.96). Use of conventional disease-modifying antirheumatic drug (DMARD) alone or in combination with biologics/Janus Kinase inhibitors was not associated with hospitalisation (OR 1.23, 95% CI 0.70 to 2.17 and OR 0.74, 95% CI 0.37 to 1.46, respectively). Non-steroidal anti-inflammatory drug (NSAID) use was not associated with hospitalisation status (OR 0.64, 95% CI 0.39 to 1.06). Tumour necrosis factor inhibitor (anti-TNF) use was associated with a reduced odds of hospitalisation (OR 0.40, 95% CI 0.19 to 0.81), while no association with antimalarial use (OR 0.94, 95% CI 0.57 to 1.57) was observed. CONCLUSIONS: We found that glucocorticoid exposure of ≥10 mg/day is associated with a higher odds of hospitalisation and anti-TNF with a decreased odds of hospitalisation in patients with rheumatic disease. Neither exposure to DMARDs nor NSAIDs were associated with increased odds of hospitalisation.


title: Efficacy and safety of Jinhua Qinggan granules for coronavirus disease 2019 (COVID-19): A protocol of a systematic review and meta-analysis

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome (SARS)-COV2 and represents the causative agent of a potentially fatal disease. Jinhua Qinggan granules has definite effect in treating COVID-19 patients, but it has not been systematically evaluated for efficacy and safety. METHODS: Retrieved the database, including the China National Knowledge Infrastructure (CNKI), Chinese Biomedical literature Database (CBM), Chinese Scientific and Journal Database (VIP), Wan Fang database, PubMed, and EMBASE. Evaluate methodological quality and judge risk of bias through the Cochrane manual. RevMan 5.3 and STATA 16.0 software were used to perform the meta-analysis. RESULTS: This study will provide high-quality evidence of Jinhua Qinggan granules for COVID-19. CONCLUSION: The conclusion of this study will provide evidence to determine whether Jinhua Qinggan granules is an effective treatment for COVID-19. PROSPERO REGISTRATION NUMBER: CRD42020182373.


Ark of Life and Hope: the role of the Cabin Hospital in facing COVID-19


International Mental Health perspectives on the novel coronavirus SARS-CoV-2 pandemic


title: Safety and immunogenicity of a parenteral trivalent P2-VP8 subunit rotavirus vaccine: a multisite, randomised, double-blind, placebo-controlled trial

text: BACKGROUND: A monovalent, parenteral, subunit rotavirus vaccine was well tolerated and immunogenic in adults in the USA and in toddlers and infants in South Africa, but elicited poor responses against heterotypic rotavirus strains. We aimed to evaluate safety and immunogenicity of a trivalent vaccine formulation (P2-VP8-P[4],[6],[8]). METHODS: A double-blind, randomised, placebo-controlled, dose-escalation, phase 1/2 study was done at three South African research sites. Healthy adults (aged 18-45 years), toddlers (aged 2-3 years), and infants (aged 6-8 weeks, ≥37 weeks' gestation, and without previous receipt of rotavirus vaccination), all without HIV infection, were eligible for enrolment. In the dose-escalation phase, adults and toddlers were randomly assigned in blocks (block size of five) to receive 30 µg or 90 µg of vaccine, or placebo, and infants were randomly assigned in blocks (block size of four) to receive 15 µg, 30 µg, or 90 µg of vaccine, or placebo. In the expanded phase, infants were randomly assigned in a 1:1:1:1 ratio to receive 15 µg, 30 µg, or 90 µg of vaccine, or placebo, in block sizes of four. Participants, parents of participants, and clinical, data, and laboratory staff were masked to treatment assignment. Adults received an intramuscular injection of vaccine or placebo in the deltoid muscle on the day of randomisation (day 0), day 28, and day 56; toddlers received a single injection of vaccine or placebo in the anterolateral thigh on day 0. Infants in both phases received an injection of vaccine or placebo in the anterolateral thigh on days 0, 28, and 56, at approximately 6, 10, and 14 weeks of age. Primary safety endpoints were local and systemic reactions (grade 2 or worse) within 7 days and adverse events and serious adverse events within 28 days after each injection in all participants who received at least one injection. Primary immunogenicity endpoints were analysed in infants in either phase who received all planned injections, had blood samples analysed at the relevant timepoints, and presented no major protocol violations considered to have an effect on the immunogenicity results of the study, and included serum anti-P2-VP8 IgA, IgG, and neutralising antibody geometric mean titres and responses measured 4 weeks after the final injection in vaccine compared with placebo groups. This trial is registered with ClinicalTrials.gov, NCT02646891. FINDINGS: Between Feb 15, 2016, and Dec 22, 2017, 30 adults (12 each in the 30 µg and 90 µg groups and six in the placebo group), 30 toddlers (12 each in the 30 µg and 90 µg groups and six in the placebo group), and 557 infants (139 in the 15 µg group, 140 in the 30 µg group, 139 in the 90 µg group, and 139 in the placebo group) were randomly assigned, received at least one dose, and were assessed for safety. There were no significant differences in local or systemic adverse events, or unsolicited adverse events, between vaccine and placebo groups. There were no serious adverse events within 28 days of injection in adults, whereas one serious adverse event occurred in a toddler (febrile convulsion in the 30 µg group) and 23 serious adverse events (four in placebo, ten in 15 µg, four in 30 µg, and five in 90 µg groups) occurred among 20 infants, most commonly respiratory tract infections. One death occurred in an infant within 28 days of injection due to pneumococcal meningitis. In 528 infants (130 in placebo, 132 in 15 µg, 132 in 30 µg, and 134 in 90 µg groups), adjusted anti-P2-VP8 IgG seroresponses (≥4-fold increase from baseline) to P[4], P[6], and P[8] antigens were significantly higher in the 15 µg, 30 µg, and 90 µg groups (99-100%) than in the placebo group (10-29%; p<0·0001). Although significantly higher than in placebo recipients (9-10%), anti-P2-VP8 IgA seroresponses (≥4-fold increase from baseline) to each individual antigen were modest (20-34%) across the 15 µg, 30 µg, and 90 µg groups. Adjusted neutralising antibody seroresponses in infants (≥2·7-fold increase from baseline) to DS-1 (P[4]), 1076 (P[6]), and Wa (P[8]) were higher in vaccine recipients than in placebo recipients: p<0·0001 for all comparisons. INTERPRETATION: The trivalent P2-VP8 vaccine was well tolerated, with promising anti-P2-VP8 IgG and neutralising antibody responses across the three vaccine P types. Our findings support advancing the vaccine to efficacy testing. FUNDING: Bill & Melinda Gates Foundation.


COVID-19: more evidence emerges


title: Detection of Unsuspected Coronavirus Disease 2019 Cases by Computed Tomography and Retrospective Implementation of the Radiological Society of North America/Society of Thoracic Radiology/American College of Radiology Consensus Guidelines

text: PURPOSE: The purpose of this article was to report the utility of computed tomography (CT) for detecting unsuspected cases of Coronavirus disease 2019 (COVID-19) and the utility of the Radiological Society of North America (RSNA)/Society of Thoracic Radiology (STR)/American College of Radiology (ACR) consensus guidelines for COVID-19 reporting. MATERIALS AND METHODS: A total of 22 patients of the 156 reverse transcriptase polymerase chain reaction confirmed COVID-19 patients who were hospitalized between March 27, 2020 and March 31, 2020 at our quaternary care academic medical center and who underwent CT imaging within 1 week of admission were included in this retrospective study. Demographics and clinical data were extracted from the electronic medical record system. Two thoracic radiologists independently categorized each CT study on the basis of RSNA/STR/ACR consensus guidelines. Disagreement in categorization was resolved by consensus discussion with a third thoracic radiologist. RESULTS: At the time of imaging, 16 patients (73%) were suspected of COVID-19, and 6 patients (27%) were not. Common symptoms at presentation were fever (73%), cough (77%), and gastrointestinal symptoms (59%). An overall 63% of suspected COVID-19 patients exhibited shortness of breath, whereas 0 unsuspected COVID-19 patients did (P=0.02). On the basis of the RSNA consensus guidelines, 68%, 18%, 9%, and 5% of studies were categorized as "typical appearance," "indeterminate appearance," "atypical appearance," and "negative for pneumonia," respectively. There was no difference of category distribution between suspected and unsuspected COVID-19 patients (P=0.20), with "typical appearance" being the most prevalent in both (69% vs. 67%, respectively). CONCLUSIONS: It is important to recognize imaging features of COVID-19 pneumonia even in unsuspected patients. Implementation of the RSNA/STR/ACR consensus guidelines may increase consistency of reporting and convey the level of suspicion for COVID-19 to other health care providers, with "typical appearance" especially warranting further attention.


title: When will the battle against novel coronavirus end in Wuhan: A SEIR modeling analysis

text: Background: Recent outbreak of 2019-nCoV in Wuhan raised serious public health concerns. By February 15, 2020 in Wuhan, the total number of confirmed infection cases has reached 37 914, and the number of deaths has reached 1123, accounting for 56.9% of the total confirmed cases and 73.7% of the total deaths in China. People are eager to know when the epidemic will be completely controlled and when people's work and life will be on the right track. Method: In this study we analyzed the epidemic dynamics and trend of 2019-nCoV in Wuhan by using the data after the closure of Wuhan city till February 12, 2020 based on the SEIR modeling method. Results: The optimal parameters were estimated as R0 = 1.44 (interquartile range: 1.40-1.47), TI = 14 (interquartile range = 14-14) and TE = 3.0 (interquartile range = 2.8-3.1). Based on these parameters, the number of infected individuals in Wuhan city may reach the peak around February 19 at about 47 000 people. Once entering March, the epidemic would gradually decline, and end around the late March. It is worth noting that the above prediction is based on the assumption that the number of susceptible population N = 200 000 will not increase. If the epidemic situation is not properly controlled, the peak of infected number can be further increased and the peak time will be a little postponed. It was expected that the epidemic would subside in early March, and disappear gradually towards the late March. Conclusions: The epidemic situation of 2019-nCoV in Wuhan was effectively controlled after the closure of the city, and the disease transmission index also decreased significantly. It is expected that the peak of epidemic situation would be reached in late February and end in March.


title: "Global Health": Time to Refocus while We still Have Time

text: Two decades of growing resource availability from agencies and foundations in wealthy countries has transformed approaches to health in poorly resourced nations. This progress looks increasingly unstable as climate change, social unrest, and, now, disruptive pandemics present threats not only to health but also to the mechanisms that manage it, and to funding itself. The growth in "global health" schools, technology development laboratories, nongovernmental organizations and multilateral institutions in donor countries has delivered not only successes but also disappointment, and reflect a paradigm that is in many ways contrary to the principles of population-based ownership that they espouse. Although the COVID-19 crisis has underlined the importance of health access and health service capacity, we may have a limited window of opportunity in which to rethink the current model and improve both efficiency and effectiveness. With a dose of humility, we may all benefit from studying our own rhetoric on human-centered design and applying these principles across global health to ensure that our approach is effective, efficient, and defensible.


Rapid and Sensitive Detection of COVID-19 Using CRISPR/Cas12a-based Detection with Naked Eye Readout, CRISPR/Cas12a-NER


title: COVID-19 and anosmia: A review based on up-to-date knowledge

text: The pandemic of Coronavirus Disease 2019 (COVID-19) has caused a vast disaster throughout the world. There is increasing evidence that olfactory dysfunction can present in COVID-19 patients. Anosmia can occur alone or can be accompanied by other symptoms of COVID-19, such as a dry cough. However, the pathogenic mechanism of olfactory dysfunction and its clinical characteristics in patients with COVID-19 remains unclear. Multiple cross-sectional studies have demonstrated that the incidence rate of olfactory dysfunction in COVID-19 patients varies from 33.9-68% with female dominance. Anosmia and dysgeusia are often comorbid in COVID-19 patients. Otolaryngologists should be mindful of the symptom of anosmia in outpatients so as not to delay the diagnosis of COVID-19. In this paper, we have reviewed the relevant knowledge based on up-to-date literature.


title: [Health protection guideline of passenger transport stations and transportation facilities during novel coronavirus pneumonia (NCP) outbreak]

text: During the coronavirus pneumonia (NCP) outbreak, the transportation industries are faced with the more burdensome tasks of outbreak prevention and control as well as ensuring smooth transportation. It is important to organize transportation in order to restore the order of production and life, ensure the normal economic and social operation, and control the outbreak in the whole society. From the perspective of health, this guideline puts forward technical requirements on the operation management, personnel requirements and health protection of passenger transportation places such as aviation, railway, subway, bus, taxi, ship, etc., which reduces the impact of the NCP outbreak on the transportation industry and personal health risks.


COVID-19 Response in Sub-Saharan Low-Resource Setting: Healthcare Soldiers Need Bullets.


docid: stgzvqeu

title: Letter to the Editors: Additional Factors to Consider When Studying Liver Injury Indicators and Mortality in COVID-19 Patients

text: In a recent issue of Hepatology, Lei et al.(1) conducted a multicenter retrospective cohort study that included 5,771 adult patients with coronavirus disease 2019 (COVID-19) pneumonia in Hubei Province. The purpose of the study was to evaluate the relationships between liver injury indicators (alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [ALP], and total bilirubin [TBIL]) and mortality in COVID-19 patients. The authors considered the possibility that elevated liver injury indicators, particularly AST, are strongly associated with mortality risk. However, the association between liver injury indicators and mortality in COVID-19 patients should be interpreted cautiously in light of the following issues.


title: Indications and timing for tracheostomy in patients with SARS CoV2-related

text: BACKGROUND: The indications and timing for tracheostomy in patients with SARS CoV2-related are controversial. PURPOSE: In a recent issue published in the European Archives of Otorhinolaryngology, Mattioli et al. published a short communication about tracheostomy timing in patients with COVID-19 (Coronavirus Disease 2019); they reported that the tracheostomy could allow early Intensive Care Units discharge and, in the context of prolonged Invasive Mechanical Ventilation, should be suggested within 7 and 14 days to avoid potential tracheal damages. In this Letter to the Editor we would like to present our experience with tracheostomy in a Hub Covid Hospital. METHODS: 8 patients underwent open tracheostomy in case of intubation prolonged over 14 days, bronchopulmonary overlap infections, and patients undergoing weaning. They were followed up and the number and timing of death were recorded. RESULTS: Two patients died after tracheostomy; the median time between tracheostomy and death was 3 days. A negative prognostic trend was observed for a shorter duration of intubation. CONCLUSION: In our experience, tracheostomy does not seem to influence the clinical course and prognosis of the disease, in the face of possible risks of contagion for healthcare workers. The indication for tracheostomy in COVID-19 patients should be carefully evaluated and reserved for selected patients. Although it is not possible to define an optimal timing, it is our opinion that tracheostomy in a stable or clinically improved COVID-19 patient should not be proposed before the 20th day after orotracheal intubation.


title: A Stroke Care Model at an Academic, Comprehensive Stroke Center During the 2020 COVID-19 Pandemic

text: BACKGROUND AND PURPOSE: The COVID-19 pandemic has required the adaptation of hyperacute stroke care (including stroke code pathways) and hospital stroke management. There remains a need to provide rapid and comprehensive assessment to acute stroke patients while reducing the risk of COVID-19 exposure, protecting healthcare providers, and preserving personal protective equipment (PPE) supplies. While the COVID infection is typically not a primary cerebrovascular condition, the downstream effects of this pandemic force adjustments to stroke care pathways to maintain optimal stroke patient outcomes. METHODS: The University of California San Diego (UCSD) Health System encompasses two academic, Comprehensive Stroke Centers (CSCs). The UCSD Stroke Center reviewed the national COVID-19 crisis and implications on stroke care. All current resources for stroke care were identified and adapted to include COVID-19 screening. The adjusted model focused on comprehensive and rapid acute stroke treatment, reduction of exposure to the healthcare team, and preservation of PPE. AIMS: The adjusted pathways implement telestroke assessments as a specific option for all inpatient and outpatient encounters and accounts for when telemedicine systems are not available or functional. COVID screening is done on all stroke patients. We outline a model of hyperacute stroke evaluation in an adapted stroke code protocol and novel methods of stroke patient management. CONCLUSIONS: The overall goal of the model is to preserve patient access and outcomes while decreasing potential COVID-19 exposure to patients and healthcare providers. This model also serves to reduce the use of vital PPE. It is critical that stroke providers share best practices via academic and vetted social media platforms for rapid dissemination of tools and care models during the COVID-19 crisis.


title: Transmission of SARS-CoV-2 via fecal-oral and aerosols-borne routes: Environmental dynamics and implications for wastewater management in underprivileged societies

text: The advent of novel human coronavirus (SARS-CoV-2) and its potential transmission via fecal-oral and aerosols-borne routes are upcoming challenges to understand the fate of the virus in the environment. In this short communication, we specifically looked at the possibilities of these transmission routes based on the available literature directly related to the SARS-CoV-2 as well as on the closer phylogenetic relatives such as SARS-CoV-1. The available data suggest that, in addition to human-to-human contact, the virus may spread via fecal-oral and aerosols-borne routes. Existing knowledge states that coronaviruses have low stability in the environment due to the natural action of oxidants that disrupt the viral envelope. Previous recommended dosage of chlorination has been found to be not sufficient to inactivate SARS-CoV-2 in places where viral load is high such as hospitals and airports. Although there is no current evidence showing that coronaviruses can be transmitted through contaminated drinking water, there is a growing concern on the impact of the current pandemic wave on underprivileged societies because of their poor wastewater treatment infrastructures, overpopulation, and outbreak management strategies. More research is encouraged to trace the actual fate of SARS-CoV-2 in the environment and to develop/revise the disinfection strategies accordingly.


title: Impaired immune cell cytotoxicity in severe COVID-19 is IL-6 dependent

text: BACKGROUND: Coronavirus disease 19 (COVID-19) is an emerging infectious disease caused by SARS-CoV-2. Anti-viral immune response is crucial to achieve pathogen clearance, however in some patients an excessive and aberrant host immune response can lead to an acute respiratory distress syndrome. The comprehension of the mechanisms that regulate pathogen elimination, immunity, and pathology is essential to better characterize disease progression and widen the spectrum of therapeutic options. METHODS: We performed a flow cytometric characterization of immune cells subsets from 30 COVID-19 patients and correlated these data with clinical outcomes. RESULTS: COVID-19 patients showed decreased numbers of circulating T, B and NK cells, and exhibited a skewing of CD8+ T cells towards a terminally differentiated/senescent phenotype. In agreement, T CD4+, T CD8+ but also NK cells displayed reduced anti-viral cytokine production capability. Moreover, a reduced cytotoxic potential was identified in COVID-19 patients, particularly in those that required intensive care. The latter group of patients showed also increased serum IL-6 levels, that correlated to the frequency of granzyme-expressing NK cells. Off-label treatment with tocilizumab restored the cytotoxic potential of NK cells. CONCLUSION: In conclusion, the association between IL-6 serum levels and the impairment of cytotoxic activity suggests the possibility that targeting this cytokine may restore anti-viral mechanisms. FUNDING: This study was supported by funds of Dept. of Experimental and Clinical Medicine of University of Florence (ex-60%) derived from Ministero dell'Istruzione, dell'Università e della Ricerca (Italy).


Anesthetic Management of Patients Undergoing Aortic Dissection Repair With Suspected Severe Acute Respiratory Syndrome Coronavirus Disease 2019 (COVID-19) Infection


title: [Comparison of epidemic characteristics between SARS in 2003 and COVID-19 in 2020 in Guangzhou]

text: Objective: By analyzing the epidemic characteristics and related indicators of SARS and COVID-19, to explore the reasons for the similarities and differences of the two epidemics, so as to provide reference for epidemic prevention and control. Methods: The general situation, clinical classification, activity history, contact history, family members' contact and incidence of the two infectious diseases in Guangzhou were collected and used to analyze the time characteristics, occupational characteristics, age characteristics and other key indicators of the two diseases, including the number of cases, composition ratio (%), mean, median, crude mortality, etc. Results: A total of 1 072 cases of SARS were included in the study. Three hundred and fifty three were severe cases with the incidence of 30.13%. Forty three cases of death were reported with a mortality rate of 4.01%. The average age was 46 years old, and 26.31% of the cases were medical staff. The interval time between first report to continuous zero reports was 129 days. As to COVID-19, a total of 346 cases were included. 58 of which were severe cases with the incidence of 16.67%. One case of death was reported with a mortality rate of 0.29%. The average age was 38 years old, and no hospital infection among medical staff was reported. The interval time between first report to continuous zero reports was 35 days. Conclusions: The prevention and control strategies for COVID-19 were more effective compared to that of SARS, and the emergency response procedures were worth to be evaluated and summarized.


title: [Discussion on early warning, prevention and control of emerging infectious diseases from a macroscopic perspective based on big data and effective distance model: enlightenment of COVID-19 epidemic data in China]

text: Objective: To provide a system for warning, preventing and controlling emerging infectious diseases from a macroscopic perspective, using the COVID-19 epidemic data and effective distance model. Methods: The dates of hospitalization/isolation treatment of the first confirmed cases of COVID-19 and the cumulative numbers of confirmed cases in different provinces in China reported as of 23 February, 2020 were collected. The Location Based Service (LBS) big data platform of "Baidu Migration" was employed to obtain the data of the proportion of the floating population from Wuhan to all parts of the country. Effective distance models and linear regression models were established to analyze the relationship between the effective distance and the arrival time of the epidemic as well as the number of cumulative confirmed cases at provincial and municipal levels. Results: The arrival time of the epidemic and the cumulative number of confirmed cases of COVID-19 had significant linear relationship at both provincial and municipal levels in China, and the regression coefficients of each linear model were significant (P<0.001). At the provincial level, the effective distance could explain about 71% of the variation of the model with arrival time along with around 90% of the variation for the model in the cumulative confirmed case magnitude; at the municipal level, the effective distance could explain about 66% of the variation for the model in arrival time, and about 85% of the variation of the model with the cumulative confirmed case magnitude. Conclusions: The fitting degree of the models are good. The LBS big data and effective distance model can be used to estimate the track, time and extent of epidemic spread to provide useful reference for early warning, prevention and control of emerging infectious diseases.


Launching a public statewide tele(oral)medicine service in Brazil during COVID-19 pandemic


title: Antiviral activity of lycorine against Zika virus in vivo and in vitro

text: The emergence and re-emergence of Zika virus (ZIKV), is a cause for international concern. These highly pathogenic arboviruses represent a serious health burden in tropical and subtropical areas worldwide. Despite these burdens, antiviral therapies do not exist, and inhibitors of ZIKV are therefore urgently needed. To elucidate the anti-ZIKV effect of lycorine, we used reverse transcription-quantitative real-time PCR (qRT-PCR), immunofluorescence, Westernwestern blot, and plaque forming assay to analyse viral RNA (vRNA), viral protein, progeny virus counts, and validated inhibitors in vitro using a variety of cell lines. Additionally, we found that lycorine acts post-infection according to time-of-addition assay, and inhibits RdRp activity. Lycorine protected AG6 mice against ZIKV-induced lethality by decreasing the viral load in the blood. Due to its potency and ability to target ZIKV infection in vivo and in vitro, lycorine might offer promising therapeutic possibilities for combatting ZIKV infections in the future.


EU guidance impedes humanitarian action to prevent COVID-19 in Syria


End-of-life decisions and care in the midst of a global coronavirus (COVID-19) pandemic


title: TraceSecure: Towards Privacy Preserving Contact Tracing

text: Contact tracing is being widely employed to combat the spread of COVID-19. Many apps have been developed that allow for tracing to be done automatically based off location and interaction data generated by users. There are concerns, however, regarding the privacy and security of users data when using these apps. These concerns are paramount for users who contract the virus, as they are generally required to release all their data. Motivated by the need to protect users privacy we propose two solutions to this problem. Our first solution builds on current"message based"methods and our second leverages ideas from secret sharing and additively homomorphic encryption.


docid: elieuuuy

title: Epidemiology, diagnosis, treatment, and future perspectives concerning SARS-COV-2: a review article

text: The present study aimed to review the epidemiology, clinical manifestation, laboratory diagnosis, treatment, and future perspectives related to COVID-19 infections. The following electronic databases were used searched: MEDLINE, SCIELO, and LILACS. It became clear that COVID-19 infections occur through exposure to the virus, and both the immunosuppressed and healthy population appear susceptible. The clinical course of COVID-19 is still not clear, although the SARS-CoV-2 infection seems to develop with mild, influenza-like symptoms in the vast majority of subjects, i.e., 10%-15% of COVID-19 patients. Since rRT-PCR tests serve as the gold standard method to confirm a SARS-CoV-2 infection, false-negative results could hinder the prevention and control of the epidemic, particularly considering the test plays a key role in the decision for continued isolated medical observation or discharge. Our findings also indicate that a radical increase in the identification and isolation of currently undocumented infections would be needed to fully control SARS-CoV2.