title: Current status of mesenchymal stem cell therapy for immune/inflammatory lung disorders: Gleaning insights for possible use in COVID-19

text: The broad immunomodulatory properties of human mesenchymal stem cells (MSCs) has allowed for wide application in regenerative medicine as well as immune/inflammatory diseases, including unmatched allogeneic use. The novel coronavirus disease COVID-19 has unleashed a pandemic in record time accompanied by an alarming mortality rate mainly due to pulmonary injury and acute respiratory distress syndrome. Since there are no effective preventive or curative therapies currently, MSC therapy (MSCT) has emerged as a possible candidate despite the lack of preclinical data of MSCs for COVID-19. Interestingly, MSCT preclinical data specifically on immune/inflammatory disorders of the lungs were among the earliest to be reported in 2003, with the first clinical use of MSCT for graft-vs-host disease reported in 2004. Since these first reports, preclinical data showing beneficial effects of MSC immunomodulation have accumulated substantially, and as a consequence, over a third of MSCT clinical trials now target immune/inflammatory diseases. There is much preclinical evidence for MSCT in noninfectious-including chronic obstructive pulmonary disease, asthma, and idiopathic pulmonary fibrosis-as well as infectious bacterial immune/inflammatory lung disorders, with data generally demonstrating therapeutic effects; however, for infectious viral pulmonary conditions, the preclinical evidence is more scarce with some inconsistent outcomes. In this article, we review the mechanistic evidence for clinical use of MSCs in pulmonary immune/inflammatory disorders, and survey the ongoing clinical trials-including for COVID-19-of MSCT for these diseases, with some perspectives and comment on MSCT for COVID-19.


Inclusion of pregnant women in clinical trials of COVID-19 therapies: what have we learned?


Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection


Clinical features of discharged COVID-19 patients with an extended SARS-CoV-2 RNA positive signal in respiratory samples


Modelling-based evaluation of the effect of quarantine control by the Chinese government in the coronavirus disease 2019 outbreak


Covid-19: experts question analysis suggesting half UK population has been infected


title: Genomic diversity of SARS-CoV-2 in Coronavirus Disease 2019 patients

text: BACKGROUND: A novel coronavirus (SARS-CoV-2) has infected more than 75,000 individuals and spread to over 20 countries. It is still unclear how fast the virus evolved and how the virus interacts with other microorganisms in the lung. METHODS: We have conducted metatranscriptome sequencing for the bronchoalveolar lavage fluid of eight SARS-CoV-2 patients, 25 community-acquired pneumonia (CAP) patients, and 20 healthy controls. RESULTS: The median number of intra-host variants was 1-4 in SARS-CoV-2 infected patients, which ranged between 0 and 51 in different samples. The distribution of variants on genes was similar to those observed in the population data (110 sequences). However, very few intra-host variants were observed in the population as polymorphism, implying either a bottleneck or purifying selection involved in the transmission of the virus, or a consequence of the limited diversity represented in the current polymorphism data. Although current evidence did not support the transmission of intra-host variants in a person-to-person spread, the risk should not be overlooked. The microbiota in SARS-CoV-2 infected patients was similar to those in CAP, either dominated by the pathogens or with elevated levels of oral and upper respiratory commensal bacteria. CONCLUSION: SARS-CoV-2 evolves in vivo after infection, which may affect its virulence, infectivity, and transmissibility. Although how the intra-host variant spreads in the population is still elusive, it is necessary to strengthen the surveillance of the viral evolution in the population and associated clinical changes.


title: Relationship between ABO blood group distribution and clinical characteristics in patients with COVID-19

text: OBJECTIVE: To explore ABO blood group distribution and clinical characteristics in patients with COVID-19. METHODS: The clinical data of 187 patients with COVID-19 seen between January 20, 2020 and March 5, 2020 at the First Hospital of Changsha were retrospectively analyzed. The differences in the ABO blood group distribution between COVID-19 patients and the control group (1991 cases) were analyzed. The relationship between blood type and clinical characteristics was analyzed. RESULTS: Of the 187 patients with COVID-19, 69 had type A (36.90%), 63 had type B (33.69%), 41 had type O (21.92%), and 14 had type AB blood (7.49%). The proportion of patients with type A blood in the COVID-19 group was significantly higher than that in the control group (36.90% vs. 27.47%, P = 0.006), while the proportion of patients with type O blood in the COVID-19 group was significantly lower than that in the control group (21.92% vs. 30.19%, P = 0.018). The risk of COVID-19 was higher for individuals with blood group A than for those with blood group O (OR = 1.849, 95% CI = 1.228-2.768, P = 0.003). The risk of COVID-19 was higher for patients with blood group A than for those with a blood group other than A (OR = 1.544, 95% CI = 1.122-2.104, P = 0.006). Patients with blood group O had a lower risk of COVID-19 than non-O blood group patients (OR = 0.649, 95% CI = 0.457-0.927, P = 0.018). The ABO blood group distribution was related to COVID-19 status. CONCLUSIONS: Patients with blood group A had an increased risk for infection with SARS-CoV-2, whereas blood group O was associated with a decreased risk, indicating that certain ABO blood groups were correlated with SARS-CoV-2 susceptibility. Blood type was related to some clinical characteristics of patients with COVID-19.


title: COVID-19 in a social reinsurance framework: Forewarned is forearmed

text: The crisis caused by COVID-19 revealed the global unpreparedness to handle the impact of a pandemic. In this paper, we present a statistical analysis of the data related to the COVID-19 outbreak in China, specifically the infection speed, death and fatality rates in Hubei province. By fitting distributions of these quantities we design a parametric reinsurance contract whose trigger and cap are based on the probability distributions of the infection speed, death and fatality rates. In particular, fitting the distribution for the infection speed and death rates we provide a measure of the effectiveness of a state's action during an epidemic, and propose a reinsurance contract as a supplement to a state's social insurance to alleviate financial costs.


title: Care for Patients with Musculoskeletal Pain During the COVID-19 Pandemic: Physical Therapy and Rehabilitation Suggestions for Pain Management

text: Coronavirus disease 2019 has severely affected public health. Under social distancing and lockdown policies, patients with musculoskeletal pain have fewer opportunities than usual to receive routine medical care for pain management in hospitals. Therefore, we provided some suggestions for such patients to manage musculoskeletal pain and techniques that may be performed at home during this period.


Vaso-occlusive crisis and acute chest syndrome in sickle cell disease due to 2019 novel coronavirus disease (COVID-19)


Introduction: "COVID-19: Politics, Inequalities, and Pandemic"


title: CoViD-19: sapevamo tutto ma non avevamo capito niente./ [CoViD-19: we knew everything but we didn't understand anything.]

text: The CoViD-19 and its consequences could perhaps have been foreseen. Above all, this pandemic force us to review what is essential and really necessary in term of priorities and regulatory process for clinical pharmacological research. It is evident, among other things, the difficulty to deal with therapeutic uncertainties.Not proven specific therapies are available for the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2, the cause of CoViD-19), other than supportive care. However, several clinical centres decided to use off label drugs as a standard of care in the absence of efficacy and safety data. The national regulatory body (AIFA) has set up a process in a short time to transparently govern the approval of new trials and to regulate the use of medicines that are not indicated. In this context, the communication of risk associated with experimental therapies was also very important. The lessons we will learn from this emergency may result crucial in redesigning a better way of conducting clinical trials and information on drugs.


Covid-19: Indian government vows to protect healthcare workers from violence amid rising cases


title: Multi-Criteria Decision Analysis to prioritize hospital admission of patients affected by COVID-19 in low-resource settings with hospital-bed shortage

text: OBJECTIVE: To use Multi-Criteria Decision Analysis (MCDA) to determine weights for eleven criteria in order to prioritize COVID-19 non-critical patients for admission to hospital in healthcare settings with limited resources. METHODS: The MCDA was applied in two main steps: specification of criteria for prioritizing COVID-19 patients (and levels within each criterion); and determination of weights for the criteria based on experts' knowledge and experience in managing COVID-19 patients, via an online survey. Criteria were selected based on available COVID-19 evidence with a focus on low- and middle-income countries (LMICs). RESULTS: The most important criteria (mean weights, summing to 100%), are: PaO2 (16.3%); peripheral O2 saturation (15.9%); chest X-ray (14.1%); Modified Early Warning Score-MEWS (11.4%); respiratory rate (9.5%); comorbidities (6.5%); living with vulnerable people (6.4%); body mass index (5.6%); duration of symptoms before hospital evaluation (5.4%); CRP (5.1%); and age (3.8%). CONCLUSIONS: At the beginning of a new pandemic, when evidence for disease predictors is limited or unavailable and effective national contingency plans are difficult to establish, the MCDA prioritization model could play a pivotal role in improving the response of health systems.


Legal Immunity for Physicians During the COVID-19 Pandemic: Needs to Address Legal and Ethical Challenges


Risk of COVID-19 Transmission During Autopsy


title: Clinical characteristics of 19 neonates born to mothers with COVID-19

text: The aim of this study was to investigate the clinical characteristics of neonates born to SARS-CoV-2 infected mothers and increase the current knowledge on the perinatal consequences of COVID-19. Nineteen neonates were admitted to Tongji Hospital from January 31 to February 29, 2020. Their mothers were clinically diagnosed or laboratory-confirmed with COVID-19. We prospectively collected and analyzed data of mothers and infants. There are 19 neonates included in the research. Among them, 10 mothers were confirmed COVID-19 by positive SARS-CoV-2 RT-PCR in throat swab, and 9 mothers were clinically diagnosed with COVID-19. Delivery occurred in an isolation room and neonates were immediately separated from the mothers and isolated for at least 14 days. No fetal distress was found. Gestational age of the neonates was 38.6 ± 1.5 weeks, and average birth weight was 3293 ± 425 g. SARS-CoV-2 RT-PCR in throat swab, urine, and feces of all neonates were negative. SARS-CoV-2 RT-PCR in breast milk and amniotic fluid was negative too. None of the neonates developed clinical, radiologic, hematologic, or biochemical evidence of COVID-19. No vertical transmission of SARS-CoV-2 and no perinatal complications in the third trimester were found in our study. The delivery should occur in isolation and neonates should be separated from the infected mothers and care givers.


Covid-19: Why test? Who to test? How to test?


Adapting to a novel disruptive threat: Nuclear Cardiology Service in the time of the Coronavirus (COVID-19) Outbreak 2020 (SARS REBOOT)


title: Focus on a 2019-novel coronavirus (SARS-CoV-2)

text: A new coronavirus, severe acute respiratory syndrome coronavirus 2, was first discovered in Wuhan, China, in December 2019. As of April 7, 2020, the new coronavirus has spread quickly to 184 countries and aroused the attention of the entire world. No targeted drugs have yet been available for intervention and treatment of this virus. The sharing of academic information is crucial to risk assessment and control activities in outbreak countries. In this review, we summarize the epidemiological, genetic and clinical characteristics of the virus as well as laboratory testing and treatments to understand the nature of the virus. We hope this review will be helpful to prevent viral infections in outbreak countries and regions.


docid: mehixlhp

title: COVID-19 and Nigeria: putting the realities in context

text: BACKGROUND: Coronavirus disease 2019 (COVID-19), which was previously known as 2019-novel coronavirus (2019-nCoV), was first reported in Wuhan, China in December 2019. The disease evolved into a serious global emergency, leading to its declaration as a pandemic. DISCUSSION: On the African continent, Nigeria is just experiencing the direct effects of this pandemic, having recorded her index case in February 2020, with an increasing number of cases every day and a current case fatality ratio of 0.03 as at 13 April 2020. Although the recorded cases may seem low, it has been forecast that Africa will have some of the worst effects of this disease by the end of the pandemic. Generally, African countries have fragile health systems and this remains a source of concern, especially in the event of increased outbreaks. Nigeria's current national health systems cannot effectively respond to the growing needs of already infected patients requiring admission into intensive care units for acute respiratory diseases and severe acute respiratory syndrome (SARS COV-2) pneumonia. This has grim implications for Nigeria, especially as increased cases loom that may require critical care. Provision of quarantine or isolation facilities and availability of rapid diagnostic kits for fast and reliable testing and diagnosis of the disease can also be a challenge in Africa. CONCLUSION: There is an urgent need to put into perspective these realities peculiar to Africa including Nigeria and explore available collective measures and interventions to address the COVID-19 pandemic.


Metastatic melanoma treatment with checkpoint inhibitors in the COVID-19 era: experience from an Italian Skin Cancer Unit


title: Prognostication and Proactive Planning in COVID-19

text: Accurate prognostication is challenging in the setting of SARS-CoV-2, the virus responsible for COVID-19, due to rapidly changing data, studies that are not generalizable, and lack of morbidity and functional outcomes in survivors. To provide meaningful guidance to patients, existing mortality data must be considered and appropriately applied. Although most people infected with SARS-CoV-2 will recover, mortality increases with age and comorbidity in those who develop severe illness.


Prevention of COVID-19 in patients with inflammatory bowel disease in Wuhan, China


title: Low-dose radiation therapy for COVID-19 pneumopathy: what is the evidence?

text: In the current dismal situation of the COVID-19 pandemic, effective management of patients with pneumonia and acute respiratory distress syndrome is of vital importance. Due to the current lack of effective pharmacological concepts, this situation has caused interest in (re)considering historical reports on the treatment of patients with low-dose radiation therapy for pneumonia. Although these historical reports are of low-level evidence per se, hampering recommendations for decision-making in the clinical setting, they indicate effectiveness in the dose range between 0.3 and 1â¯Gy, similar to more recent dose concepts in the treatment of acute and chronic inflammatory/degenerative benign diseases with, e.g., a single dose per fraction of 0.5â¯Gy. This concise review aims to critically review the evidence for low-dose radiation treatment of COVID-19 pneumopathy and discuss whether it is worth investigating in the present clinical situation.


title: COVID-19 model-based practice changes in managing a large prostate cancer practice: following the trends during a month-long ordeal

text: Coronavirus (COVID-19) has been a life-changing experience for both individuals and institutions. We describe changes in our practice based on real-time assessment of various national and international trends of COVID-19 and its effectiveness in the management of our resources. Initial risk assessment and peak resource requirement using the COVID-19 Hospital Impact Model for Epidemics (CHIME) and McKinsey models. Strengths, weaknesses, opportunities, and threats (SWOT) analysis of our practice's approach during the pandemic. Based on CHIME the community followed 60% social distancing, the number of expected new patients hospitalized at maximum surge would be 401, with 100 patients requiring ventilator support. In contrast, when the community followed 15% social distancing, the maximum surge of hospitalized new patients would be 1823 and 455 patients would require a ventilator. on April 15, the expected May requirement of ICU beds at peak would be 68, with 61 patients needing ventilators. The estimated surge numbers improved throughout April, and on April 22 the expected ICU bed peak in May would be 11.7, and those requiring ventilator would be 10.5. Simultaneously, within a month, our surgical waitlist grew from 585 to over 723 patients. Our SWOT analysis revealed our internal strengths and inherent weakness, relevant to the pandemic. A graded and a guarded response to this type of situation is crucial in managing patients in a large practice.


title: Ethical considerations during the COVID-19 pandemic

text: The care of patients during the COVID-19 pandemic has added many layers of complexity to ethical issues. Our response emphasizes the importance of having an ethically sound framework to inform our decisions, requiring caregivers to consider what is ethically optimal and feasible for the patient. It is increasingly important to understand the ethical principles and to appropriately apply them to both patient management decisions and guide scarce resource allocation. If we are to be prepared to face the many challenges of this pandemic, we must prioritize the ethical demands to our treatment and management concerns.


title: Distress and anxiety associated with COVID-19 among Jewish and Arab pregnant women in Israel

text: INTRODUCTION: The fact that little is yet known about the possible implications of COVID-19 for pregnancy, puts pregnant women at greater risk of heightened anxiety and psychological distress. In this study, we sought to explore the psychological distress and COVID-19-related anxiety of pregnant women during the crisis. METHODS: Israeli Jewish and Arab pregnant women (n = 336) aged 20-47 completed a set of questionnaires during the COVID-19 pandemic in March 2020. RESULTS: The levels of all COVID-19-related anxieties were quite high (much or very much), with the highest regarding public places and transportation (87.5%, 70%, respectively), followed by concerns over the possible infection of other family members and the health of the foetus (71.7%, 70%, respectively), going for pregnancy check-ups (68.7%,), being infected themselves, and the delivery (59.2%, 55.4%, respectively). Although COVID-19-related anxieties were shared by pregnant women characterised by diverse sociodemographic variables, with very small nuances, Arab women were more anxious about each of the issues than Jewish women. DISCUSSION: Our findings highlight the importance of assessing anxiety and distress in pregnant women during the COVID-19 pandemic, as well as the need to be attentive to the double stress of pregnant women in times of crisis and to the potential vulnerability of subgroups, such as cultural minorities.


title: Assessment of the quality of systematic reviews on COVID-19: A comparative study of previous coronavirus outbreaks

text: Several systematic reviews (SRs) have been conducted on the COVID-19 outbreak, which together with the SRs on previous coronavirus outbreaks, form important sources of evidence for clinical decision and policy making. Here, we investigated the methodological quality of SRs on COVID-19, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS). Online searches were performed to obtain SRs on COVID-19, SARS, and MERS. The methodological quality of the included SRs was assessed using the AMSTAR-2 tool. Descriptive statistics were used to present the data. In total, of 49 SRs that were finally included in our study, 17, 16, and 16 SRs were specifically on COVID-19, MERS, and SARS, respectively. The growth rate of SRs on COVID-19 was the highest (4.54/month) presently. Of the included SRs, 6, 12, and 31 SRs were of moderate, low, and critically low quality, respectively. SRs on SARS showed the optimum quality among the SRs on the three diseases. Subgroup analyses showed that the SR topic (P < .001), the involvement of a methodologist (P < .001), and funding support (P = .046) were significantly associated with the methodological quality of the SR. According to the adherence scores, adherence to AMSTAR-2 items sequentially decreased in SRs on SARS, MERS, and COVID-19. The methodological quality of most SRs on coronavirus outbreaks is unsatisfactory, and those on COVID-19 have higher risks of poor quality, despite the rapid actions taken to conduct SRs. The quality of SRs should be improved in the future. Readers must exercise caution in accepting and using the results of these SRs.


docid: pwlcflxj

title: Intestinal ischemia in the COVID-19 era


Interpreting a covid-19 test result


Work in the Time of Coronavirus


Guidance needed for singlehanded GPs to deal with covid-19 pandemic


An Observational Study to Identify Types of Personal Protective Equipment Breaches on Inpatient Wards


docid: swoibevc

title: Obesity and SARS-CoV-2: A population to safeguard

text: Evidence has lately emerged regarding an increased risk of SARS-CoV-2 with worse prognosis in patients with obesity, especially among the young. Weight excess is a well-established respiratory disease risk factor, and the newly reported correlation is therefore unsurprising. The underlying pathophysiology is likely multi-stranded, ranging from complement system hyperactivation, increased Interleukin-6 secretion, chronic inflammation, presence of comorbidities such as diabetes and hypertension, and a possible local, detrimental effect within the lung. Further understanding the link between obesity and SARS-CoV-2 is crucial, as this could aid proper tailoring of immunomodulatory treatments, together with improving stratification among those possibly requiring critical care.


Managing appendicitis during the COVID-19 pandemic in the UK


docid: tkxsvybh

title: Triage of patients with COVID-19


title: Correlation between immune response and self-reported depression during convalescence from COVID-19

text: Self-reported depression has been observed in coronavirus disease-2019 (COVID-19) patients, infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), during discharge from the hospital. However, the cause of this self-reported depression during the convalescent period remains unclear. Here, we report the mental health status of 96 convalescent COVID-19 patients who were surveyed using an online questionnaire at the Shenzhen Samii Medical Center from March 2 to March 12, 2020 in Shenzhen, China. After obtaining their informed consent, we retrospectively analyzed the clinical characteristics of patients, including routine blood and biochemical data. The results suggested that patients with self-reported depression exhibited increased immune response, as indicated by increased white blood cell and neutrophil counts, as well as neutrophil-to-lymphocyte ratio. However, the mechanism linking self-reported depression to these cellular changes needs further study. In conclusion, self-reported depression occurred at an early stage in convalescent COVID-19 patients, and changes in immune function were apparent during short-term follow-up of these patients after discharge. Appropriate psychological interventions are necessary, and changes in immune function should be emphasized during long-term follow up of these patients.


title: Follow-up of skin lesions during the evolution of COVID-19: a case report

text: The disease caused by the new coronavirus (COVID-19) has many systemic manifestations affecting the upper airways, lungs, gastrointestinal tract and inducing hematological repercussions. With the evolution of the pandemic, skin lesions were observed. However, there is little information about the evolution of the lesions at this moment. The authors report a case of a patient who had more than one exposure to the coronavirus during the evolution of the disease and manifested different types of edematous lesions. The lesions started in the prodromal period and changed their presentation and localization during the evolution of COVID-19. The lesions regressed quickly with the use of corticoid cream and antihistamine. Viral skin lesions are frequent causes of exanthema. However, viral etiology is not always investigated in acute urticarial and atypical erythematous-edematous conditions. The immunological basis of acute urticaria has points in common with COVID-19, justifying the appearance of lesions. Investigation of viral etiology should always be remembered in acute urticarial and edematous conditions.


Anotaciones breves sobre el síndrome de liberación de citocinas y el bloqueo terapéutico de la interleucina-6 en SARS-CoV-2/COVID-19


Use of Hydroxychloroquine and Chloroquine During the COVID-19 Pandemic: What Every Clinician Should Know


The importance of Coronavirus Disease 2019 testing in cardiac surgery


docid: elzrzehe

title: Importance of suppression and mitigation measures in managing COVID-19 outbreaks

text: I employ a simple mathematical model of an epidemic process to evaluate how four basic quantities: the reproduction number (R), the numbers of sensitive (S) and infectious individuals(I), and total community size (N) affect strategies to control COVID-19. Numerical simulations show that strict suppression measures at the beginning of an epidemic can create low infectious numbers, which thereafter can be managed by mitigation measures over longer periods to flatten the epidemic curve. The stronger the suppression measure, the faster it achieves the low numbers of infections that are conducive to subsequent management. We discuss the predictions of this analysis and how it fits into longer-term sequences of measures, including using the herd immunity concept to leverage acquired immunity.


COVID-19: rethinking risk


title: COVID-19 outbreak and cancer radiotherapy disruption in Italy: Survey endorsed by the Italian Association of Radiotherapy and Clinical Oncology (AIRO)

text: Italy experienced one of the world's deadliest COVID-19 outbreaks and healthcare systems had to instantly reorganise activity. The Italian Radiation Oncology Departments adapted numerous solutions to minimize the disruptions. Information technologies, treatment prioritization and implementation of hypofractionation and protection procedures allowed balancing between cancer patient care and patient/healthcare workers safety.


docid: vocaxdrw

title: Elevated cardiac biomarkers are associated with increased mortality for inpatients with COVID-19: A retrospective case-control study


The dilemma of renin-angiotensin system inhibitors in coronavirus disease 2019 (COVID-19): insights into lung fluid handling and gas exchange in heart failure patients


A risk-based approach to experimental early phase clinical trials during the COVID-19 pandemic


Nasal Endoscopy During COVID-19


title: Prevalence and socio-demographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19

text: Psychological health problems, especially emotional disorders, are common among adolescents. The epidemiology of emotional disorders is greatly influenced by stressful events. This study sought to assess the prevalence rate and socio-demographic correlates of depressive and anxiety symptoms among Chinese adolescents affected by the outbreak of COVID-19. We conducted a cross-sectional study among Chinese students aged 12-18 years during the COVID-19 epidemic period. An online survey was used to conduct rapid assessment. A total of 8079 participants were involved in the study. An online survey was used to collect demographic data, assess students' awareness of COVID-19, and assess depressive and anxiety symptoms with the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) questionnaire, respectively. The prevalence of depressive symptoms, anxiety symptoms, and a combination of depressive and anxiety symptoms was 43.7%, 37.4%, and 31.3%, respectively, among Chinese high school students during the COVID-19 outbreak. Multivariable logistic regression analysis revealed that female gender was the higher risk factor for depressive and anxiety symptoms. In terms of grades, senior high school was a risk factor for depressive and anxiety symptoms; the higher the grade, the greater the prevalence of depressive and anxiety symptoms. Our findings show there is a high prevalence of psychological health problems among adolescents, which are negatively associated with the level of awareness of COVID-19. These findings suggest that the government needs to pay more attention to psychological health among adolescents while combating COVID-19.


title: 24th Collegium Ramazzini Statement: Prevention of Work-Related Infection in the COVID-19 Pandemic

text: BACKGROUND.: Workers whose occupations put them in contact with infected persons and the public are at increased risk of COVID-19 infection. RECOMMENDATIONS.: The Collegium Ramazzini calls on governments at all levels to protect worker health by strengthening public health systems; maintaining comprehensive social insurance systems; establishing policies that presume all COVID-19 infections in high-risk workers are work-related; enforcing all occupational health standards; and developing pandemic preparedness plans.The Collegium Ramazzini calls on all employers - large and small, public and private - to protect the health of all workers by developing disease preparedness plans; implementing basic infection control measures; establishing disease identification and isolation policies; reducing hazardous exposures; supporting personal protective equipment (PPE) programs; and restricting unnecessary travel. CONCLUSION.: Governments and employers have legal obligations to protect worker health. They are not relieved of these duties during pandemics.


In reply: Uncertainty in using chest computed tomography in early coronavirus disease (COVID-19)


title: Social distancing, population density, and spread of COVID-19 in England: a longitudinal study

text: BACKGROUND: The UK government introduced social distancing measures between 16-22 March 2020, aiming to slow down transmission of COVID-19. AIM: To explore the spreading of COVID-19 in relation to population density after the introduction of social distancing measures. DESIGN & SETTING: Longitudinal design with 5-weekly COVID-19 incidence rates per 100 000 people for 149 English Upper Tier Local Authorities (UTLAs), between 16 March and 19 April 2020. METHOD: Multivariable multilevel model to analyse weekly incidence rates per 100 000 people; time was level-1 unit and UTLA level-2 unit. Population density was divided into quartiles. The model included an interaction between week and population density. Potential confounders were percentage aged ≥65, percentage non-white British, and percentage in two highest classes of the National Statistics Socioeconomic Classification. Co-variates were male life expectancy at birth, and COVID-19 prevalence rate per 100 000 people on March 15. Confounders and co-variates were standardised around the mean. RESULTS: Incidence rates per 100 000 people peaked in the week of March 30-April 5, showing higher adjusted incidence rate per 100 000 people (46.2; 95% confidence interval [CI] = 40.6 to 51.8) in most densely populated ULTAs (quartile 4) than in less densely populated ULTAs (quartile 1: 33.3, 95% CI = 27.4 to 37.2; quartile 2: 35.9, 95% CI = 31.6 to 40.1). Thereafter, incidence rate dropped in the most densely populated ULTAs resulting in rate of 22.4 (95% CI = 16.9 to 28.0) in the week of April 13-19; this was lower than in quartiles 1, 2, and 3, respectively 31.4 (95% CI = 26.5 to 36.3), 34.2 (95% CI = 29.9 to 38.5), and 43.2 (95% CI = 39.0 to 47.4). CONCLUSION: After the introduction of social distancing measures, the incidence rates per 100 000 people dropped stronger in most densely populated ULTAs.


Pandemically challenged: Developing a ward-based cross-skilling programme


Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury


Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study


title: Management of patients with suspected or confirmed COVID-19, in the radiology department

text: OBJECTIVES: From December 2019, a novel coronavirus disease named COVID-19 was reported in China. Within 3 months, the World Health Organization defined COVID-19 as a pandemic, with more than 370,000 cases and 16,000 deaths worldwide. In consideration of the crucial role of diagnostic testing during COVID-19, the aim of this technical note was to provide a complete synthesis of approaches implemented for the management of suspected or confirmed COVID-19 patients. KEY FINDINGS: The planning of a robust plan to prevent the transmission of the virus to patients and department staff members should be fundamental in each radiology service. Moreover, the speed of spread and the incidence of the pandemic make it necessary to optimize the use of personal protective devices and dedicated COVID-19 equipment, given the limited availability of supplies. CONCLUSION: In the management of radiographic and CT imaging, staff should take special precautions to limit contamination between patients and other patients or professionals. IMPLICATIONS FOR PRACTICE: An isolated imaging room should be dedicated to suspected or confirmed COVID-19 cases, including radiography and CT scanners. This paper will provide guidance concerning disposable protective gear to be utilized, as well as on the cleaning and sanitation of radiology room and equipment.


title: Cardiovascular conditions and COVID-19

text: Although COVID-19 primarily affects the respiratory system, cardiovascular involvement is common, especially in individuals who are severely ill.


title: Viral kinetics of SARS-CoV-2 in asymptomatic carriers and presymptomatic patients

text: From a total of 71 laboratory-confirmed cases, three presymptomatic patients and 10 patients with entirely asymptomatic infections were identified. In two of the three incubation period patients, the viral titer in the presymptomatic period was very high (Ct value<20). The median number of days to first negative RT-PCR in the asymptomatic carriers was 4.5 (range 2.5-9), and all asymptomatic carriers reached a first RT-PCR Ct>35 within 14 days after diagnosis. Patients who have COVID-19 may already be infectious before there are symptoms, and 14 days of isolation after diagnosis may be sufficient in entirely asymptomatic cases.


title: Analysis of the causes of moral injury in the outbreak of 2019-nCoV

text: The infection of the novel coronavirus that originated from Wuhan, China in December 2019 converted rapidly into a pandemic by March 11, 2020. Whereas the infection mortality rate is not completely understood, it seems to be significantly beyond that of other recent pandemics (e.g., H1N1 pandemic). This paper discusses moral injury in the context of disaster and epidemic and how easily the moral psychology of individuals and society can be shaken. Moral injury is a multiscientific concept involving psychology, culture, and religion. Amid the outbreak of the novel coronavirus pneumonia, immoral behaviors and events such as violence, injury, and illness have also caused different degrees of impact on the moral standards of individuals, confusing moral cognition, destroying moral emotion, and weakening moral toughness, resulting in varying degrees of moral injury. If there is no national health, there will be no positive society for all. Based on this, the public needs to pay close attention to the moral health of the whole people and effectively avoid the occurrence of moral injury. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Understanding and Interpretation of Case Fatality Rate of Coronavirus Disease 2019


Dentists at Birmingham devise indexing tool to aid triage


title: SARS-CoV-2 infection and stem cells: Interaction and intervention

text: The emergence of the novel severe acute respiratory coronavirus 2 (SARS-CoV-2) in China and its rapid national and international spread have created a global health emergency. The resemblance with SARS-CoV in spike protein suggests that SARS-CoV-2 employs spike-driven entry into angiotensin-converting enzyme 2 (ACE2)-expressing cells. From a stem cell perspective, this review focuses on the possible involvement of ACE2+ stem/progenitor cells from both the upper and lower respiratory tracts in coronavirus infection. Viral infection-associated acute respiratory distress syndrome and acute lung injury occur because of dysregulation of the immune response. Mesenchymal stem cells appear to be a promising cell therapy given that they favorably modulate the immune response to reduce lung injury. The use of exogenous stem cells may lead to lung repair. Therefore, intervention by transplantation of exogenous stem cells may be required to replace, repair, remodel, and regenerate lung tissue in survivors infected with coronavirus. Ultimately, vaccines, natural killer cells and induced-pluripotent stem cell-derived virus-specific cytotoxic T lymphocytes may offer off-the-shelf therapeutics for preventing coronavirus reemergence.


COVID-19 with spontaneous pneumomediastinum


Walking the line between benefit and harm from tracheostomy in COVID-19


docid: ayqigfmr

title: Hyperbaric oxygen therapy in preventing mechanical ventilation in COVID-19 patients: a retrospective case series

text: OBJECTIVE: A pandemic afflicts the entire world. The highly contagious SARS-CoV-2 virus originated in Wuhan, China in late 2019 and rapidly spread across the entire globe. According to the World Health Organization (WHO), the novel Coronavirus (COVID-19)has infected more than two million people worldwide, causing over 160,000 deaths. Patients with COVID-19 disease present with a wide array of symptoms, ranging from mild flu-like complaints to life threatening pulmonary and cardiac complications. Older people and patients with underlying disease have an increased risk of developing severe acute respiratory syndrome (SARS) requiring mechanical ventilation. Once intubated, mortality increases exponentially. A number of pharmacologic regimens, including hydroxychloroquine-azithromycin, antiviral therapy (eg, remdesevir), and anti-IL-6 agents (e.g., toclizumab), have been highlighted by investigators over the course of the pandemic, based on the therapy's potential to interrupt the viral life-cycle of SARS-CoV-2 or preventing cytokine storm. At present, there have been no conclusive series of reproducible randomised clinical trials demonstrating the efficacy of any one drug or therapy for COVID-19. CASES: COVID-19 positive patients (n=5) at a single institution received hyperbaric oxygen therapy (HBOT) between 13 and 20 April 2020. All the patients had tachypnoea and low oxygen saturation despite receiving high FiO2. HBOT was added to prevent the need for mechanical ventilation. A standard dive profile of 2.0ATA for 90 minutes was employed. Patients received between one and six treatments in one of two dedicated monoplace hyperbaric chambers. RESULTS: All the patients recovered without the need for mechanical ventilation. Following HBOT, oxygen saturation increased, tachypnoea resolved and inflammatory markers fell. At the time of writing, three of the five patients have been discharged from the hospital and two remain in stable condition. CONCLUSION: This small sample of patients exhibited dramatic improvement with HBOT. Most importantly, HBOT potentially prevented the need for mechanical ventilation. Larger studies are likely to define the role of HBOT in the treatment of this novel disease.


Guarding a city from the COVID-19 pandemic


title: Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 in Wuhan, China: a retrospective study

text: BACKGROUND: The 2019 novel coronavirus has caused the outbreak of the acute respiratory disease in Wuhan, Hubei Province of China since December 2019. This study was performed to analyze the clinical characteristics of patients who succumbed to and who recovered from 2019 novel coronavirus disease (COVID-19). METHODS: Clinical data were collected from two tertiary hospitals in Wuhan. A retrospective investigation was conducted to analyze the clinical characteristics of fatal cases of COVID-19 (death group) and we compare them with recovered patients (recovered group). Continuous variables were analyzed using the Mann-Whitney U test. Categorical variables were analyzed by χ test or Fisher exact test as appropriate. RESULTS: Our study enrolled 109 COVID-19 patients who died during hospitalization and 116 recovered patients. The median age of the death group was older than the recovered group (69 [62, 74] vs. 40 [33, 57] years, Zâ=â9.738, Pâ<â0.001). More patients in the death group had underlying diseases (72.5% vs. 41.4%, χâ=â22.105, Pâ<â0.001). Patients in the death group had a significantly longer time of illness onset to hospitalization (10.0 [6.5, 12.0] vs. 7.0 [5.0, 10.0] days, Zâ=â3.216, Pâ=â0.001). On admission, the proportions of patients with symptoms of dyspnea (70.6% vs. 19.0%, χâ=â60.905, Pâ<â0.001) and expectoration (32.1% vs. 12.1%, χâ=â13.250, Pâ<â0.001) were significantly higher in the death group. The blood oxygen saturation was significantly lower in the death group (85 [77, 91]% vs. 97 [95, 98]%, Zâ=â10.625, Pâ<â0.001). The white blood cell (WBC) in death group was significantly higher on admission (7.23 [4.87, 11.17] vs. 4.52 [3.62, 5.88] ×10/L, Zâ=â7.618, Pâ<â0.001). Patients in the death group exhibited significantly lower lymphocyte count (0.63 [0.40, 0.79] vs. 1.00 [0.72, 1.27] ×10/L, Zâ=â8.037, Pâ<â0.001) and lymphocyte percentage (7.10 [4.45, 12.73]% vs. 23.50 [15.27, 31.25]%, Zâ=â10.315, Pâ<â0.001) on admission, and the lymphocyte percentage continued to decrease during hospitalization (7.10 [4.45, 12.73]% vs. 2.91 [1.79, 6.13]%, Zâ=â5.242, Pâ<â0.001). Alanine transaminase (22.00 [15.00, 34.00] vs. 18.70 [13.00, 30.38] U/L, Zâ=â2.592, Pâ=â0.010), aspartate transaminase (34.00 [27.00, 47.00] vs. 22.00 [17.65, 31.75] U/L, Zâ=â7.308, Pâ<â0.001), and creatinine levels (89.00 [72.00, 133.50] vs. 65.00 [54.60, 78.75] µmol/L, Zâ=â6.478, Pâ<â0.001) were significantly higher in the death group than those in the recovered group. C-reactive protein (CRP) levels were also significantly higher in the death group on admission (109.25 [35.00, 170.28] vs. 3.22 [1.04, 21.80] mg/L, Zâ=â10.206, Pâ<â0.001) and showed no significant improvement after treatment (109.25 [35.00, 170.28] vs. 81.60 [27.23, 179.08] mg/L, Zâ=â1.219, Pâ=â0.233). The patients in the death group had more complications such as acute respiratory distress syndrome (ARDS) (89.9% vs. 8.6%, χâ=â148.105, Pâ<â0.001), acute cardiac injury (59.6% vs. 0.9%, χâ=â93.222, Pâ<â0.001), acute kidney injury (18.3% vs. 0%, χâ=â23.257, Pâ<â0.001), shock (11.9% vs. 0%, χâ=â14.618, Pâ<â0.001), and disseminated intravascular coagulation (DIC) (6.4% vs. 0%, χâ=â7.655, Pâ=â0.006). CONCLUSIONS: Compared to the recovered group, more patients in the death group exhibited characteristics of advanced age, pre-existing comorbidities, dyspnea, oxygen saturation decrease, increased WBC count, decreased lymphocytes, and elevated CRP levels. More patients in the death group had complications such as ARDS, acute cardiac injury, acute kidney injury, shock, and DIC.


title: Survey data of COVID-19-related Knowledge, Risk Perceptions and Precautionary Behavior among Nigerians

text: In response to the global call for strategic information to understand the novel coronavirus, the dataset presented in this paper is an examination of COVID-19-related knowledge, risk perceptions and precautionary health behavior among Nigerians. The data were generated during the COVID-19 lockdown in the country through a survey distributed via an online questionnaire, assessing socio-demographic information (7 items), knowledge (5 items), information sources (1 item), risk perception (9 items), expected end of lockdown (1 item), and COVID-19 precautionary health behavior (10 items), from 28th March to 4th April, 2020, gathering a total of 1,357 responses. A combination of purposive and snowball techniques helped to select the respondents via Whatsapp and Facebook from 180 cities/towns in the 6 geopolitical zones of Nigeria. The survey data were analyzed using descriptive and inferential statistics. The entire dataset is stored in a Microsoft Excel Worksheet (xlsx) and the questionnaire is attached as a supplementary file. The data will assist in curbing the Coronavirus pandemic by offering evidence for strategic and targeted interventions as well as health policy formulations and implementation.


title: [Rationales for using JAK 1/2 inhibitors in severely afflicted patients with COVID-19 pneumonia]

text: Severely afflicted patients with the COVID-19 may become in need of mechanical ventilation. The cause of acute respiratory failure is a massive hyperinflammation in the lungs, and treatment with glucocorticoids is not recommended by the WHO. A rare haematological disease, the virus-associated haemophagocytic lymphohistiocytosis syndrome (HLS), is associated with high mortality and a similar hyperinflammation syndrome. Janus kinase (JAK) 1/2 inhibitor treatment is highly efficacious in HLS. In this review, we discuss the rationales and perspectives for using JAK1/2 inhibitors in severely afflicted patients with COVID-19 pneumonia.


Recomendaciones éticas y clínicas para la toma de decisiones en el entorno residencial en contexto de la crisis de COVID-19./ Recomendaciones éticas y clínicas para la toma de decisiones en el entorno residencial en contexto de la crisis de COVID-19./ Clinical and ethical recommendations for decision-making in nursing homes in the context of the COVID-19 crisis


docid: wpwpliue

title: Organization of acute patients' transfer to rehabilitation services during COVID-19 crisis


title: [Epidemiological characteristics of confirmed COVID-19 cases in Tianjin]

text: Objective: To investigate the clinical and epidemiological characteristics of 135 confirmed cases of COVID-19 in Tianjin. Methods: The clinical and epidemiological data of 135 cases of COVID-19 in Tianjin were collected, and the data were analyzed with descriptive method. The factors influencing the severity of the illness were analyzed. Results: Among the 135 COVID-19 cases, 72 were males and 63 were females, the age of the cases was (48.62±16.83) years, and the case fatality rate was 2.22%. Local transmission caused 74.81% of the cases. A total of 33 clusters occurred, involving 85.92% of all COVID-19 cases. The median of the incubation period of COVID-19 was 6.50 days, the average generation interval was 5 days, and the household secondary transmission rate was 20.46%. Fever was the main symptom (78.63%), followed by cough (56.48%). Multivariate regression analysis indicated that age (OR=1.038, 95%CI: 1.010-1.167) and the number of chronic underlying diseases (OR=1.709, 95%CI: 1.052-2.777) were the risk factors of severe illness. Conclusions: Fever was the main symptom at the early phase of COVID-19 in Tianjin, and the local cluster cases accounted for high proportion in confirmed COVID-19 cases reported in Tianjin. Severe illness was prone to occur in people with old age and multi underlying diseases. Strict isolation of close contacts and intensive care of high-risk groups are the main measures to reduce the morbidity and case fatality of COVID-19.


Digital technology and COVID-19


Navigating the Unchartered Waters in the Time of COVID-19


title: Hematological features of persons with COVID-19

text: We studied admission and dynamic demographic, hematological and biochemical co-variates in 1449 hospitalized subjects with coronavirus infectious disease-2019 (COVID-19) in five hospitals in Wuhan, Hubei province, China. We identified two admission co-variates: age (Odds Ratio [OR] = 1.18, 95% Confidence Interval [CI] [1.02, 1.36]; P = 0.026) and baseline D-dimer (OR = 3.18 [1.48, 6.82]; P = 0.003) correlated with an increased risk of death in persons with COVID-19. We also found dynamic changes in four co-variates, Δ fibrinogen (OR = 6.45 [1.31, 31.69]; P = 0.022), Δ platelets (OR = 0.95 [0.90-0.99]; P = 0.029), Δ C-reactive protein (CRP) (OR = 1.09 [1.01, 1.18]; P = 0.037), and Δ lactate dehydrogenase (LDH) (OR = 1.03 [1.01, 1.06]; P = 0.007) correlated with an increased risk of death. The potential risk factors of old age, high baseline D-dimer, and dynamic co-variates of fibrinogen, platelets, CRP, and LDH could help clinicians to identify and treat subjects with poor prognosis.


title: The natural history and transmission potential of asymptomatic SARS-CoV-2 infection

text: BACKGROUND: Little is known about the natural history of asymptomatic SARS-CoV-2 infection or its contribution to infection transmission. METHODS: We conducted a prospective study at a quarantine center for COVID-19 in Ho Chi Minh City, Vietnam. We enrolled quarantined people with RT-PCR-confirmed SARS-CoV-2 infection, collecting clinical data, travel and contact history, and saliva at enrolment and daily nasopharyngeal throat swabs (NTS) for RT-PCR testing. We compared the natural history and transmission potential of asymptomatic and symptomatic individuals. RESULTS: Between March 10th and April 4th, 2020, 14,000 quarantined people were tested for SARS-CoV-2; 49 were positive. Of these, 30 participated in the study: 13(43%) never had symptoms and 17(57%) were symptomatic. 17(57%) participants acquired their infection outside Vietnam. Compared with symptomatic individuals, asymptomatic people were less likely to have detectable SARS-CoV-2 in NTS samples collected at enrolment (8/13 (62%) vs. 17/17 (100%) P=0.02). SARS-CoV-2 RNA was detected in 20/27 (74%) available saliva; 7/11 (64%) in the asymptomatic and 13/16 (81%) in the symptomatic group (P=0.56). Analysis of the probability of RT-PCR positivity showed asymptomatic participants had faster viral clearance than symptomatic participants (P<0.001 for difference over first 19 days). This difference was most pronounced during the first week of follow-up. Two of the asymptomatic individuals appeared to transmit the infection to up to four contacts. CONCLUSIONS: Asymptomatic SARS-CoV-2 infection is common and can be detected by analysis of saliva or NTS. NTS viral loads fall faster in asymptomatic individuals, but they appear able to transmit the virus to others.


title: Rose Petal Extract (Rosa gallica) Exerts Skin Whitening and Anti-Skin Wrinkle Effects

text: We sought to investigate the effect of extracts from Rosa gallica petals (RPE) on skin whitening and anti-wrinkle activity. Tyrosinase activity was attenuated by RPE treatment, concomitant with the reduction of melanin accumulation in human B16F10 melanoma. Treatment of the facial skin of volunteers in a clinical trial with an RPE-containing formulation enhanced skin brightness (L* value) significantly. The underlying mechanism responsible was determined to be associated with mitogen-activated protein kinase (MAPK) activation. In addition, RPE exhibited anti-wrinkle formation activity of human dermal fibroblasts by suppressing matrix metalloproteinase (MMP)-1 level. In vivo study, RPE also inhibited solar ultraviolet-stimulated MMP-1 level by c-Jun regulation. Overall, our findings indicate that RPE evokes skin whitening and anti-wrinkle formation activity by regulating intracellular signaling, supporting its utility as an ingredient for skin whitening and anti-wrinkle cosmetic products.


Sheltering in Place in a Xenophobic Climate: COVID-19 and Children in Immigrant Families


Letter to editor: brain awareness week, CoVID-19 infection and neurological sciences


A DNA Aptamer Based Method for Detection of SARS-CoV-2 Nucleocapsid Protein


title: Will the COVID-19 pandemic slow down in the Northern hemisphere by the onset of summer? An epidemiological hypothesis

text: The COVID-19 pandemic has affected most countries of the world. As corona viruses are highly prevalent in the cold season, the question remains whether or not the pandemic will improve with increasing temperatures in the Northern hemisphere. We use data from a primary care registry of almost 15,000 patients over 20 years to retrieve information on viral respiratory infection outbreaks. Our analysis suggests that the severity of the pandemic will be softened by the seasonal change to summer.


Diagnostic and clinical significance of "atypical" symptoms in coronavirus disease 2019


title: Efficient network immunization under limited knowledge

text: Targeted immunization or attacks of large-scale networks has attracted significant attention by the scientific community. However, in real-world scenarios, knowledge and observations of the network may be limited thereby precluding a full assessment of the optimal nodes to immunize (or remove) in order to avoid epidemic spreading such as that of current COVID-19 epidemic. Here, we study a novel immunization strategy where only $n$ nodes are observed at a time and the most central between these $n$ nodes is immunized (or attacked). This process is continued repeatedly until $1-p$ fraction of nodes are immunized (or attacked). We develop an analytical framework for this approach and determine the critical percolation threshold $p_c$ and the size of the giant component $P_{\infty}$ for networks with arbitrary degree distributions $P(k)$. In the limit of $n\to\infty$ we recover prior work on targeted attack, whereas for $n=1$ we recover the known case of random failure. Between these two extremes, we observe that as $n$ increases, $p_c$ increases quickly towards its optimal value under targeted immunization (attack) with complete information. In particular, we find a new scaling relationship between $|p_c(\infty)-p_c(n)|$ and $n$ as $|p_c(\infty)-p_c(n)|\sim n^{-1}\exp(-\alpha n)$. For Scale-free (SF) networks, where $P(k)\sim k^{-\gamma}, 2<\gamma<3$, we find that $p_c$ has a transition from zero to non-zero when $n$ increases from $n=1$ to order of $\log N$ ($N$ is the size of network). Thus, for SF networks, knowledge of order of $\log N$ nodes and immunizing them can reduce dramatically an epidemics.


Could we benefit from oral self-examination during the COVID-19 pandemic?


Preparing to Perform Trauma and Orthopaedic Surgery on Patients with COVID-19


title: Lay perspectives on social distancing and other official recommendations and regulations in the time of COVID-19: a qualitative study of social media posts

text: BACKGROUND: COVID-19 caused by a new form of coronavirus (SARS-CoV-2) first appeared in China end of 2019 and quickly spread to all counties of the world. To slow down the spread of the virus and to limit the pressure on the health care systems, different regulations and recommendations have been implemented by authorities, comprising amongst others the closure of all entertainment venues and social distancing. These measures have received mixed reactions, particularly from young individuals, with many not following available advice. Drawing on the information in social media discussion forums, the present study explores the reasons why people ignore the orders and recommendations of the authorities and why the authorities are unable to produce a shared sense of inclusion concerning protective measures against the COVID-19 outbreak. METHODS: Three open-access social media forums (Reddit, Twitter, and YouTube comments) were systematically searched with respect to COVID-19-related beliefs, attitudes, and behaviours of individuals. The data was retrieved in the first 3 weeks of March 2020. Qualitative document analysis and qualitative content analysis were used as the methodical approach. The data was reviewed by all authors and jointly interpreted to minimise inconsistencies. RESULTS: The study reveals that reasons such as information pollution on social media, the persistence of uncertainty about the rapidly spreading virus, the impact of the social environment on the individual, and fear of unemployment associated with inequality in the distribution of income lead people to ignore the orders and recommendations of the authorities. The findings suggest that government representatives and politicians could not produce a shared sense of inclusion concerning protective measures against the COVID-19 outbreak, due to not building trust among the public and taking concrete economic steps to satisfy them. CONCLUSION: In uncertain crises, transparency in the presentation of information and government policies emerge as influential determinants in creating social susceptibility and solidarity. The differences between social classes constitute one of the important factors that affect the decision-making mechanisms of individuals in determining the necessary steps to be undertaken in times of crisis.


SARS-CoV-2-mediated inflammatory response in lungs: should we look at RAGE?


title: An Invited Commentary on 'Evidence Based Management Guideline for the COVID-19 pandemic- Review article'

text: COVID 19 been declared recently as a pandemic, to date has affected over 1,8881,365 with over 119,403 deaths in accordance to the global pandemic Real-Time Report. In this paper, the prime motive is to enlighten the key variables to the public on the pandemic and essential key points to note and practice in accordance to standard regulation to curb the aggressive COVID-19 pandemic.


title: Virus-induced genetics revealed by multidimensional precision medicine transcriptional workflow applicable to COVID-19

text: Precision medicine requires the translation of basic biological understanding to medical insights, mainly applied to characterization of each unique patient. In many clinical settings, this requires tools that can be broadly used to identify pathology and risks. Patients often present to the intensive care unit with broad phenotypes, including multiple organ dysfunction syndrome (MODS) resulting from infection, trauma, or other disease processes. Etiology and outcomes are unique to individuals, making it difficult to cohort patients with MODS, but presenting a prime target for testing/developing tools for precision medicine. Using multitime point whole blood (cellular/acellular) total transcriptomics in 27 patients, we highlight the promise of simultaneously mapping viral/bacterial load, cell composition, tissue damage biomarkers, balance between syndromic biology versus environmental response, and unique biological insights in each patient using a single platform measurement. Integration of a transcriptome workflow yielded unexpected insights into the complex interplay between host genetics and viral/bacterial specific mechanisms, highlighted by a unique case of virally induced genetics (VIG) within one of these 27 patients. The power of RNA-Seq to study unique patient biology while investigating environmental contributions can be a critical tool moving forward for translational sciences applied to precision medicine.


Mental health in the COVID-19 pandemic


Screening for low testosterone is needed for early identification and treatment of men at high risk of mortality from Covid-19


Handling children in COVID wards: A narrative experience and suggestions for providing psychological support


title: [Democracy and Covid-19 mortality in Europe.]

text: OBJECTIVE: In Europe there is a great variability in mortality by Covid-19 among different countries While some countries, such as Greece, Belarus or Ukraine, have a mortality rate of less than 5 cases/100,000 inhabitants, other countries such as Belgium, Spain or the United Kingdom have a mortality rate of well over 50 cases/100,000 inhabitants It is generally considered that the reason for this variability is multifactorial (including political reasons), but there are few studies that associate factors related to this variability The objective of this work was to analyse political risk factors/markers that could explain the variability in mortality due to Covid-19 among different European countries METHODS: This is a retrospective, multinational, ecological study based on the exploitation of the database provided by the European Centre for Disease Prevention and Control which collects daily information worldwide on new cases and deaths The accumulated mortality of Covid-19 in European countries (with more than 100 deaths on 01/05/2020) was calculated up to 29/05/2020 Political variables were compiled from different sources in the countries included in the study The variables analysed were: the democracy index and the different factors included in it, the country's political system and the country's corruption index On the other hand, specific political measures implemented in the different countries were collected, such as the number of days elapsed from the notification of the first infected person to 100 infected persons, to lockdown, to the closure of schools or the cancelation of meetings The number of people infected up to the date of lockdown was also registered For the statistical analysis of the association between the dependent variable (mortality) and the factors studied, correlation index were calculated, and the association was studied through univariate and multivariate linear regression models RESULTS: At May 1 2020, 27 European countries had at least 100 deaths The mean mortality was 19 83 cases/100,000 inhabitants (SD 22 4) and a median of 7 95 Mortality varied from a minimum of 1 49 cases/100,000 population in Ukraine to 82 19 cases/100,000 population in Belgium About factors analyzed both the democracy index (as well as the factors included in it), the political system (full democracy vs no) and the corruption index were statistically associated with mortality Also, the time until the implementation of the political measures was associated with mortality CONCLUSIONS: In Europe, there is a west to east (from highest to lowest) gradient in the mortality of Covid-19 Some of the observed mortality variability can be explained by political factors


title: Clinical trials during COVID-19

text: As this ever-evolving pandemic lays itself, more of its impact is being understood. Until recently, most guidelines were reported to aid in managing and treating suspected or confirmed cases. Research institutions around the world are responding with a sense of confusion. Some are continuing routinely, especially those who are overseeing clinical trials that could offer life-saving therapies, particularly against the novel coronavirus. Since research must continue even in the face of a shutdown, we aim to collate the currently available recommendations from various organizations and provide guidance to head and neck researchers across the world during these trying times.


title: Clinical and Surgical Assistance in Prostate Cancer during the COVID-19 Pandemic: Implementation of assistance protocols

text: PURPOSE: Propose an approach of prostate cancer (PCa) patients during COVID-19 pandemic. MATERIAL AND METHODS: We conducted a review of current literature related to surgical and clinical management of patients during COVID-19 crisis paying special attention to oncological ones and especially those suffering from PCa. Based on these publications and current urological guidelines, a manual to manage PCa patients is suggested. RESULTS: Patients suffering from cancer are likely to develop serious complications from COVID-19 disease together with an increased risk of postoperative morbidity and mortality. Therefore, the management of oncological patients should be taken into special consideration and most of the treatments postponed. In case the procedure is not deferrable, it should be adapted to the current situation. While the shortest radiotherapy (RT) regimens should be applied, surgical procedures must undergo the following recommendations proposed by main surgical associations. PCa prognosis is generally favourable and therefore one can safely delay most of the biopsies up to 6 months without interfering with survival outcomes in the vast majority of cases. In the same way, most of the localised PCa patients are suitable for active surveillance (AS) or hormonal therapy until local definitive treatment could be reconsidered. In metastatic as well as castration resistant PCa stages, adding androgen receptor targeted agents (abiraterone, apalutamide, darolutamide or enzalutamide) to androgen-deprivation therapy (ADT) could be considered in high risk patients. On the contrary, chemotherapy, immunotherapy and Radium-223 must be avoided with regard to the consequence of hematologic toxicity and risk of COVID-19 infection because of immunodepression. CONCLUSIONS: Most of the biopsies should be delayed while AS is advised in those patients with low risk PCa. ADT allows us to defer definitive local treatment in many cases of intermediate and high risk PCa. In regard to metastatic and castration resistant PCa, combination therapies with abiraterone, apalutamide, darolutamide or enzalutamide could be considered. Chemotherapy, Radium-223 and immunotherapy are discouraged.


Free, online videos for distance learning in medical genetics


Some Lessons Learned About Diabetes and COVID-19 During the Early Stage of the Epidemic in Norway


Seroconversion rate and diagnostic accuracy of serological tests for COVID-19


title: [The critical role of environmental hygiene and disinfection in the prevention and control of COVID-19 pandemic]

text: In response to the COVID-19 pandemic, China has adopted a series of prevention and control measures such as case isolation, close contact tracking management, environmental hygiene improvements, disinfection, and personal protection. At present, China has achieved remarkable results in the control of COVID-19. This article outlines the role of environmental hygiene and disinfection in the prevention and control of COVID-19 and analyzes relevant policies and countermeasures, which has been proved effective and deserved for extensive implementation in this combat. Suggestions are also provided for the further development of this field.


Lupus Anticoagulant and Abnormal Coagulation Tests in Patients with Covid-19


Psychological symptoms among frontline healthcare workers during COVID-19 outbreak in Wuhan


When Tithonus met corona: the COVID-19 pandemic and acute illness in the elderly


Lopinavir/ritonavir in COVID-19 patients: maybe yes, but at what dose?


COVID-19: Why Declining Biodiversity Puts Us at Greater Risk for Emerging Infectious Diseases, and What We Can Do


title: Importance of inclusion of pregnant and breastfeeding women in COVID-19 therapeutic trials

text: Investigators are employing unprecedented innovation in the design of clinical trials to rapidly and rigorously assess potentially promising therapies for COVID-19; this is in stark contrast to the continued near universal regressive practice of exclusion of pregnant and breastfeeding women from these trials. The few trials which allow their inclusion focus on post-exposure prophylaxis or outpatient treatment of milder disease, limiting the options available to pregnant women with severe COVID-19 to compassionate use of remdesivir, or off-label drug use of hydroxychloroquine or other therapies. These restrictions were put in place despite experience with these drugs in pregnant women. In this Viewpoint, we call attention to the need and urgency to engage pregnant women in COVID-19 treatment trials now in order to develop data-driven recommendations regarding the risks and benefits of therapies in this unique but not uncommon population.


A pandemic of Body, Mind, and Spirit: The Burden of "Social Distancing" in Rural Communities During an Era of Heightened Suicide Risk


COVID-19: Exposing digital poverty in a pandemic


A Pinch of Prevention is Worth a Pound of Cure: Proactive Dentistry in the Wake of COVID-19


title: COVID-19 with cystic features on computed tomography: A case report

text: RATIONALE: The cystic features of the novel coronavirus disease 2019 (COVID-19) found on computed tomography (CT) have not yet been reported in the published literature. We report the cystic chest CT findings of 2 patients confirmed to have COVID-19-related pneumonia. PATIENT CONCERNS: A 38-year-old man and a 35-year-old man diagnosed with severe COVID-19 pneumonia were admitted to the intensive care unit. DIAGNOSES: Chest CT findings showed multiple cysts in ground-glass opacities (bilaterally) with/without pneumothorax. The cysts had a smooth inner wall. INTERVENTIONS: The patients continued to be given oxygen by mask and received antitussive, phlegm-dispelling treatment. OUTCOMES: At follow up, there was a reduction in the number of multiple cystic lesions on CT. To date, 1 patient was discharged from hospital, while the other had been transferred to the rehabilitation department. LESSONS: COVID-19 may independently result in pulmonary cyst formation and pneumothorax; the application of a ventilator may be another causative factor.


[safe Surgical Practice in the Era of Covid-19]


A Saudi family with sickle cell disease presented with acute crises and COVID-19 infection


title: Nurses: Courageous, Committed, and Fed Up

text: The COVID-19 pandemic is a watershed moment for nurses.


Movement Disorders in the World of COVID-19


title: Assessment and Management of Anorexia Nervosa during COVID-19

text: Management of the high rates of medical and psychiatric complications, including self-harm and suicide, associated with Anorexia Nervosa require regular clinical review. However, during the current pandemic, face to face clinical assessments carry the risk of infection and transmission in this vulnerable cohort already compromised by low weight and lowered immunity. This paper describes how one service has had to adapt usual care during the COVID-19 pandemic without contributing excessively to carer burden or compromising patient safety.


title: Time-to-Death approach in revealing Chronicity and Severity of COVID-19 across the World

text: BACKGROUND: The outbreak of coronavirus disease, 2019 (COVID-19), which started from Wuhan, China, in late 2019, have spread worldwide. A total of 5,91,971 cases and 2,70,90 deaths were registered till 28th March, 2020. We aimed to predict the impact of duration of exposure to COVID-19 on the mortality rates increment. METHODS: In the present study, data on COVID-19 infected top seven countries viz., Germany, China, France, United Kingdom, Iran, Italy and Spain, and World as a whole, were used for modeling. The analytical procedure of generalized linear model followed by Gompertz link function was used to predict the impact lethal duration of exposure on the mortality rates. FINDINGS: Of the selected countries and World as whole, the projection based on 21st March, 2020 cases, suggest that a total (95% Cl) of 76 (65-151) days of exposure in Germany, mortality rate will increase by 5 times to 1%. In countries like France and United Kingdom, our projection suggests that additional exposure of 48 days and 7 days, respectively, will raise the mortality rates to10%. Regarding Iran, Italy and Spain, mortality rate will rise to 10% with an additional 3-10 days of exposure. World's mortality rates will continue increase by 1% in every three weeks. The predicted interval of lethal duration corresponding to each country has found to be consistent with the mortality rates observed on 28th March, 2020. CONCLUSION: The prediction of lethal duration was found to have apparently effective in predicting mortality, and shows concordance with prevailing rates. In absence of any vaccine against COVID-19 infection, the present study adds information about the quantum of the severity and time elapsed to death will help the Government to take necessary and appropriate steps to control this pandemic.


Patients with cancer in the era of 2019 novel coronavirus disease


title: Neural Networks and Value at Risk

text: Utilizing a generative regime switching framework, we perform Monte-Carlo simulations of asset returns for Value at Risk threshold estimation. Using equity markets and long term bonds as test assets in the global, US, Euro area and UK setting over an up to 1,250 weeks sample horizon ending in August 2018, we investigate neural networks along three design steps relating (i) to the initialization of the neural network, (ii) its incentive function according to which it has been trained and (iii) the amount of data we feed. First, we compare neural networks with random seeding with networks that are initialized via estimations from the best-established model (i.e. the Hidden Markov). We find latter to outperform in terms of the frequency of VaR breaches (i.e. the realized return falling short of the estimated VaR threshold). Second, we balance the incentive structure of the loss function of our networks by adding a second objective to the training instructions so that the neural networks optimize for accuracy while also aiming to stay in empirically realistic regime distributions (i.e. bull vs. bear market frequencies). In particular this design feature enables the balanced incentive recurrent neural network (RNN) to outperform the single incentive RNN as well as any other neural network or established approach by statistically and economically significant levels. Third, we half our training data set of 2,000 days. We find our networks when fed with substantially less data (i.e. 1,000 days) to perform significantly worse which highlights a crucial weakness of neural networks in their dependence on very large data sets ...


title: Use of Machine Learning and Artificial Intelligence to predict SARS-CoV-2 infection from Full Blood Counts in a population

text: Since December 2019 the novel coronavirus SARS-CoV-2 has been identified as the cause of the pandemic COVID-19. Early symptoms overlap with other common conditions such as common cold and Influenza, making early screening and diagnosis are crucial goals for health practitioners. The aim of the study was to use machine learning (ML), an artificial neural network (ANN) and a simple statistical test to identify SARS-CoV-2 positive patients from full blood counts without knowledge of symptoms or history of the individuals. The dataset included in the analysis and training contains anonymized full blood counts results from patients seen at the Hospital Israelita Albert Einstein, at São Paulo, Brazil, and who had samples collected to perform the SARS-CoV-2 rt-PCR test during a visit to the hospital. Patient data was anonymised by the hospital, clinical data was standardized to have a mean of zero and a unit standard deviation. This data was made public with the aim to allow researchers to develop ways to enable the hospital to rapidly predict and potentially identify SARS-CoV-2 positive patients. We find that with full blood counts random forest, shallow learning and a flexible ANN model predict SARS-CoV-2 patients with high accuracy between populations on regular wards (AUC = 94-95%) and those not admitted to hospital or in the community (AUC = 80-86%). Here, AUC is the Area Under the receiver operating characteristics Curve and a measure for model performance. Moreover, a simple linear combination of 4 blood counts can be used to have an AUC of 85% for patients within the community. The normalised data of different blood parameters from SARS-CoV-2 positive patients exhibit a decrease in platelets, leukocytes, eosinophils, basophils and lymphocytes, and an increase in monocytes. SARS-CoV-2 positive patients exhibit a characteristic immune response profile pattern and changes in different parameters measured in the full blood count that are detected from simple and rapid blood tests. While symptoms at an early stage of infection are known to overlap with other common conditions, parameters of the full blood counts can be analysed to distinguish the viral type at an earlier stage than current rt-PCR tests for SARS-CoV-2 allow at present. This new methodology has potential to greatly improve initial screening for patients where PCR based diagnostic tools are limited.


title: The Importance of Health Informatics in Public Health During the COVID-19 Pandemic

text: The COVID-19 pandemic became a challenge to all the health care systems across the world causing at places collapse of the healthcare systems and endangering the healthcare professionals and consequently the public health. One powerful tool for the healthcare systems and the policy makers is Health Informatics. This brief article presents the challenges faced by Health Informatics in supporting healthcare professionals and public health authorities in the world.


title: Association between platelet parameters and mortality in coronavirus disease 2019: Retrospective cohort study

text: BACKGROUND: Thrombocytopenia has been implicated in patients infected with severe acute respiratory syndrome coronavirus 2, while the association of platelet count and changes with subsequent mortality remains unclear. METHODS: The clinical and laboratory data of 383 patients with the definite outcome by March 1, 2020 in the Central Hospital of Wuhan were reviewed. The association between platelet parameters and mortality risk was estimated by utilizing Cox proportional hazard regression models. RESULTS: Among the 383 patients, 334 (87.2%) were discharged and survived, and 49 (12.8%) died. Thrombocytopenia at admission was associated with mortality of almost three times as high as that for those without thrombocytopenia (P < 0.05). Cox regression analyses revealed that platelet count was an independent risk factor associated with in-hospital mortality in a dose-dependent manner. An increment of per 50 × 109/L in platelets was associated with a 40% decrease in mortality (hazard ratio: 0.60, 95%CI: 0.43, 0.84). Dynamic changes of platelets were also closely related to death during hospitalization. CONCLUSIONS: Baseline platelet levels and changes were associated with subsequent mortality. Monitoring platelets during hospitalization may be important in the prognosis of patients with coronavirus disease in 2019.


title: CovidNet: To Bring Data Transparency in the Era of COVID-19

text: Timely, creditable, and fine-granular case information is vital for local communities and individual citizens to make rational and data-driven responses to the COVID-19 pandemic. This paper presents CovidNet, a COVID-19 tracking project associated with a large scale epidemic dataset, which was initiated by 1Point3Acres. To the best of our knowledge, the project is the only platform providing real-time global case information of more than 4,124 sub-divisions from over 27 countries worldwide with multi-language supports. The platform also offers interactive visualization tools to analyze the full historical case curves in each region. Initially launched as a voluntary project to bridge the data transparency gap in North America in January 2020, this project by far has become one of the major independent sources worldwide and has been consumed by many other tracking platforms. The accuracy and freshness of the dataset is a result of the painstaking efforts from our voluntary teamwork, crowd-sourcing channels, and automated data pipelines. As of May 18, 2020, the project website has been visited more than 200 million times and the CovidNet dataset has empowered over 522 institutions and organizations worldwide in policy-making and academic researches. All datasets are openly accessible for non-commercial purposes at https://coronavirus.1point3acres.com via a formal request through our APIs.


title: Erector spinae plane and intra thecal opioid (ESPITO) analgesia in radical nephrectomy utilising a rooftop incision: novel alternative to thoracic epidural analgesia and systemic morphine: a case series

text: Background Open radical nephrectomy and inferior vena cava exploration through a roof top incision involves significant peri-operative morbidity including severe postoperative pain. Although thoracic epidural analgesia provides excellent pain relief, recent trends suggest search for effective alternatives. Systemic morphine is often used as an alternative analgesic technique. However, it does not provide dynamic analgesia and can often impede recovery in patients undergoing major surgery on the abdomen. The authors present the first report of a novel analgesic regimen in this cohort with good outcomes. Methods Five patients undergoing open radical nephrectomy and inferior vena cava exploration received erector spinae plane infusion and intra thecal opioid analgesia at a tertiary care university teaching hospital. Outcomes included dynamic analgesia, length of hospital stay and complications Results Five adult patients undergoing major upper abdominal surgery, who refused thoracic epidural analgesia, received erector spinae plane infusion and intrathecal opioid analgesia. Patients reported effective dynamic analgesia, minimal use of rescue analgesia, early ambulation and enhanced recovery. Conclusion The novel regimen that avoids both epidural analgesia and systemic morphine can be an option in enabling enhanced recovery in this cohort.


Minimizing intra-hospital transmission of COVID-19: the role of social distancing


title: Mental Health Policy in the Era of COVID-19

text: The response to the global COVID-19 pandemic has important ramifications for mental health systems and the patients they serve. This article describes significant changes in mental health policy prompted by the COVID-19 crisis across five major areas: legislation, regulation, financing, accountability, and workforce development. Special considerations for mental health policy are discussed, including social determinants of health, innovative technologies, and research and evaluation. These extraordinary advances provide an unprecedented opportunity to evaluate the effects of mental health policies that may be adopted in the post-COVID-19 era in the United States.


title: Teledentistry during COVID-19 pandemic

text: BACKGROUND AND AIMS: Dentistry involves close face-to-face interaction with patients, hence during the COVID-19 pandemic, it has mostly been suspended. Teledentistry can offer an innovative solution to resume dental practice during this pandemic. In this review, we provide a brief overview of applications of teledentistry. METHODS: Articles on teledentistry, relevant to this review, were searched and consulted from PubMed, Google Scholar, and Cochrane database. RESULTS: Teledentistry is the remote facilitating of dental treatment, guidance, and education via the use of information technology instead of direct face-to-face contact with patients. Teleconsultation, telediagnosis, teletriage, and telemonitoring are subunits of teledentistry that have important functions relevant to dental practice. There are many challenges for acceptance of teledentistry by the dentists as well as patients, which need to be addressed urgently. CONCLUSION: Teledentistry can offer a novel solution to resume dental practice during the current pandemic, hence, the need of the hour is to incorporate teledentistry into routine dental practice. If not fully replace, at least teledentistry can complement the existing compromised dental system during the current pandemic.


title: Prevalence Threshold and the Geometry of Screening Curves

text: The relationship between a screening tests' positive predictive value, $\rho$, and its target prevalence, $\phi$, is proportional - though not linear in all but a special case. In consequence, there is a point of local extrema and maximum curvature defined only as a function of the sensitivity $a$ and specificity $b$ beyond which the rate of change of a test's $\rho$ drops at a differential pace relative to $\phi$. Herein, we show the mathematical model exploring this phenomenon and define the prevalence threshold $\phi_e$ point where this change occurs as: $\phi_e=\frac{\sqrt{a\left(-b+1\right)}+b-1}{(\varepsilon-1)}$, where $\varepsilon$ = $a$+$b$. From the prevalence threshold we deduce a more generalized relationship between prevalence and positive predictive value as a function of $\varepsilon$, which represents a fundamental theorem of screening, herein defined as: $\lim_{\varepsilon \to 2}\int_{0}^{1}{\rho(\phi)d\phi} = 1$. Understanding the concepts described in this work can help contextualize the validity of screening tests in real time, and help guide the interpretation of different clinical scenarios in which screening is undertaken.


It is too soon to attribute ADE to COVID-19


title: Three novel prevention, diagnostic, and treatment options for COVID-19 urgently necessitating controlled randomized trials

text: PURPOSE: Asymptomatic or minimally symptomatic infection with COVID-19 can result in silent transmission to large numbers of individuals, resulting in expansion of the pandemic with a global increase in morbidity and mortality. New ways of screening the general population for COVID-19 are urgently needed along with novel effective prevention and treatment strategies. HYPOTHESIS: A hypothetical three-part prevention, diagnostic, and treatment approach based on an up-to-date scientific literature review for COVID-19 is proposed. Regarding diagnosis, a validated screening questionnaire and digital app for COVID-19 could help identify individuals who are at risk of transmitting the disease, as well as those at highest risk for poor clinical outcomes. Global implementation and online tracking of vital signs and scored questionnaires that are statistically validated would help health authorities properly allocate essential health care resources to test and isolate those at highest risk for transmission and poor outcomes. Second, regarding prevention, no validated protocols except for physical distancing, hand washing, and isolation exist, and recently ivermectin has been published to have anti-viral properties against COVID-19. A randomized trial of ivermectin, and/or nutraceuticals that have been published to support immune function including glutathione, vitamin C, zinc, and immunomodulatory supplements (3,6 Beta glucan) could be beneficial in preventing transmission or lessening symptomatology but requires statistical validation. Third, concerning treatment, COVID-19 induced inflammation and "cytokine storm syndrome" with hemophagocytic lymphohistiocytosis (HLH)/Macrophage Activation Syndrome (MAS) have resulted in extreme morbidity and mortality in those with certain comorbidities, secondary to "acute respiratory distress syndrome" (ARDS) and multiorgan dysfunction with disseminated intravascular coagulation (DIC). Deficiency in red blood cell, serum and alveolar glutathione has been published in the medical literature for ARDS, as well as viral and bacterial pneumonias, resulting from increased levels of free radical/oxidative stress. A randomized controlled trial of blocking NF-κB and cytokine formation using glutathione precursors (N-acetyl-cysteine [NAC] and alpha lipoic acid) and PO/IV glutathione with associated anti-viral effects should be performed, along with an evaluation of Nrf2 activators (curcumin, sulforaphane glucosinolate) which have been scientifically proven to lower inflammation. Since high mortality rates from sepsis induced DIC due to COVID-19 infection has also been associated with thrombotic events and elevated levels of D-dimer, randomized controlled trials of using anticoagulant therapy with heparin is urgently required. This is especially important in patients on ventilators who have met certain sepsis induced coagulopathy (SIC) criteria. The use of acetazolamide with or without sildenafil also needs to be explored with or without heparin, since increased oxygen delivery to vital organs through prevention of thrombosis/pulmonary emboli along with carbonic anhydrase inhibition may help increase oxygenation and prevent adverse clinical outcomes. CONCLUSION AND IMPLICATIONS: A three-part prevention, diagnostic, and treatment plan is proposed for addressing the severe complications of COVID-19. Digital monitoring of symptoms to clinically diagnose early exposure and response to treatment; prevention with ivermectin as well as nutritional therapies that support a healthy immune response; treatment with anti-inflammatory therapies that block NF-κB and activate Nrf2 pathways, as well as novel therapies that address COVID-19 pneumonia and ARDS with DIC including anticoagulation and/or novel respiratory therapies with or without acetazolamide and sildenafil. These three broad-based interventions urgently need to be subjected to randomized, controlled trials.


The many estimates of the COVID-19 case fatality rate


title: Atención de los síndromes coronarios agudos durante la contingencia sanitaria por brote de SARS-CoV-2./ Care of acute coronary syndromes during the health contingency due to a SARS-CoV-2 outbreak

text: The communications accumulated in the last weeks make it clear that there is no agreement to define the best treatment strategy in patients with acute coronary syndrome (SICA). In patients presenting with an acute myocardial infarction with ST-segment elevation (IAMCESST), it has been suggested to favor fibrinolysis (FL) over primary percutaneous coronary intervention (PCI), reserving ICP for cases of failed FL1,2; however, some societies have maintained the indication of the ICPp as the repercussion method of choice3. In SICAs without ST segment elevation (SICASESST) the recommendations are very similar, favoring medical treatment over percutaneous coronary intervention in this subgroup of patients1. Several companies consider the contagion status, particularly in the SICASESST, to decide which repercussion follow3. Anticipating that the epidemiological curve in Mexico will be similar to that observed in most countries, we recommend continuing the care of patients with SICA, the catheterization rooms must maintain their operation.


Real-Time Smart Patient Monitoring and Assessment Amid COVID-19 Pandemic - an Alternative Approach to Remote Monitoring


title: A systematic review of neurological manifestations of SARS-CoV-2 infection: the devil is hidden in the details

text: BACKGROUND: We systematically reviewed available evidence for reports of neurological signs and symptoms in Coronavirus disease (COVID)-19 patients to identify cases with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection or immune-mediated reaction in the nervous system. METHODS: We followed PRISMA guidelines and used the MEDLINE, EMBASE, Google Scholar, MedRxiv and ChinaXiv databases to search for papers on COVID-19 and nervous system involvement which were published from January 1st to April 24th 2020. Data on design, sample size, neurologic assessment and related work-up were extracted. Biases were assessed with the Newcastle-Ottawa scale. RESULTS: We analysed 27 publications on potential neuroinvasive or parainfectious neurological complications of COVID-19. The reports focused on smell and taste (n=5) and evaluation of neurological symptoms and signs in cohorts (n=5). There were cases of Guillain-Barré syndrome/Miller-Fisher syndrome/cranial neuropathy (7 cases), meningitis/encephalitis (9 cases) and various other conditions (5 cases). Patients with cerebrospinal fluid (CSF) examination and in particular SARS-CoV-2 PCR was negligible. Amongst, two had a positive SARS-CoV-2 PCR exam of CSF specimen. The study of potential parenchymal involvement with magnetic resonance imaging was rare. Only 4 reports received a rating for the highest quality standards. CONCLUSION: This systematic review failed to establish comprehensive insights to nervous system manifestations of COVID-19 beyond immune-mediated complications as aftermath of respiratory symptoms. The authors therefore provide guidance for more careful clinical, diagnostic and epidemiological studies to characterize the manifestations and burden of neurological disease caused by SARS-CoV-2 on behalf of the Infectious Disease Panel of the European Academy of Neurology.


text: BACKGROUND AND PURPOSE: We systematically reviewed available evidence for reports of neurological signs and symptoms in patients with COVID-19 to identify cases with severe acute respiratory syndrome coronavirus (SARS-CoV)-2 infection or immune-mediated reaction in the nervous system. METHODS: We followed PRISMA guidelines and used the MEDLINE, EMBASE, Google Scholar, MedRxiv and ChinaXiv databases to search for articles on COVID-19 and nervous system involvement that were published from 1 January to 24 April 2020. Data on design, sample size, neurological assessment and related work-up were extracted. Biases were assessed with the Newcastle-Ottawa scale. RESULTS: We analysed 27 publications on potential neuroinvasive or parainfectious neurological complications of COVID-19. The reports focused on smell and taste (n = 5) and evaluation of neurological symptoms and signs in cohorts (n = 5). There were cases of Guillain-Barré syndrome/Miller-Fisher syndrome/cranial neuropathy (seven cases), meningitis/encephalitis (nine cases) and various other conditions (five cases). The number of patients with examination of cerebrospinal fluid and, in particular, SARS-CoV-2 polymerase chain reaction was negligible. Two had a positive SARS-CoV-2 polymerase chain reaction examination of cerebrospinal fluid specimen. Study of potential parenchymal involvement with magnetic resonance imaging was rare. Only four reports received a rating of the highest quality standards. CONCLUSIONS: This systematic review failed to establish comprehensive insights into nervous system manifestations of COVID-19 beyond immune-mediated complications in the aftermath of respiratory symptoms. The authors therefore provide guidance for more careful clinical, diagnostic and epidemiological studies to characterize the manifestations and burden of neurological disease caused by SARS-CoV-2 on behalf of the Infectious Disease Panel of the European Academy of Neurology.


title: Pandemics, privacy, and public health research

text: Sharing data expediently for pandemic response purposes exposes healthcare providers in Canada to significant regulatory uncertainty. Duplicative and contradictory ethical and legal duties flowing from overlapping sources can stifle flows of medical data among clinicians, researchers, and institutions. Authorities should support caregivers and accelerate research by providing clear guidance to the health sector. Institutions should foster robust data stewardship and standardize their practices to those recognized among the international health informatics community. Reform is critical to ensuring Canadian healthcare providers can deliver efficient health responses that are integrated with dispersed and disparate national and international approaches.


title: COVID-19 Epidemic Study II: Phased Emergence From the Lockdown in Mumbai

text: The nation-wide lockdown starting 25 March 2020, aimed at suppressing the spread of the COVID-19 disease, was extended until 31 May 2020 in three subsequent orders by the Government of India. The extended lockdown has had significant social and economic consequences and `lockdown fatigue' has likely set in. Phased reopening began from 01 June 2020 onwards. Mumbai, one of the most crowded cities in the world, has witnessed both the largest number of cases and deaths among all the cities in India (41986 positive cases and 1368 deaths as of 02 June 2020). Many tough decisions are going to be made on re-opening in the next few days. In an earlier IISc-TIFR Report, we presented an agent-based city-scale simulator(ABCS) to model the progression and spread of the infection in large metropolises like Mumbai and Bengaluru. As discussed in IISc-TIFR Report 1, ABCS is a useful tool to model interactions of city residents at an individual level and to capture the impact of non-pharmaceutical interventions on the infection spread. In this report we focus on Mumbai. Using our simulator, we consider some plausible scenarios for phased emergence of Mumbai from the lockdown, 01 June 2020 onwards. These include phased and gradual opening of the industry, partial opening of public transportation (modelling of infection spread in suburban trains), impact of containment zones on controlling infections, and the role of compliance with respect to various intervention measures including use of masks, case isolation, home quarantine, etc. The main takeaway of our simulation results is that a phased opening of workplaces, say at a conservative attendance level of 20 to 33\%, is a good way to restart economic activity while ensuring that the city's medical care capacity remains adequate to handle the possible rise in the number of COVID-19 patients in June and July.


Sintomatología digestiva y COVID-19: importancia de descartar patología quirúrgica asociada./ Sintomatología digestiva y COVID-19: importancia de descartar patología quirúrgica asociada./ Digestive symptoms and COVID-19: Importance of ruling out associated surgical pathology


docid: febiozud

title: COVID-19, hypercoagulation and what it could mean for patients with psychotic disorders


Management of venous thromboembolism during the COVID-19 pandemic