title: Aggregated Private Information Retrieval: A First Practical Implementation to Support Large-Scale Disease Analytics

text: With the outbreak of the coronavirus, governments rely more and more on location data shared by European mobile network operators to monitor the advancements of the disease. In order to comply with often strict privacy requirements, this location data, however, has to be anonymized, limiting its usefulness for making statements about a filtered part of the population, like already infected people. In this research, we aim to assist with the disease tracking efforts by designing a protocol to detect coronavirus hotspots from mobile data while still maintaining compliance with privacy expectations. We use various state-of-the-art privacy-preserving cryptographic primitives to design a protocol that can best be described as aggregated private information retrieval (APIR). Our protocol is based on homomorphic encryption, with additional measures to protect against malicious requests from clients. We have implemented our APIR protocol in the SEAL library and tested it for parameters suitable to create a coronavirus hotspot map for entire nationstates. This demonstrates that it is feasible to apply our APIR protocol to support nationwide disease analysis while still preserve the privacy of infected people.


title: α-Lipoic acid induces Endoplasmic Reticulum stress-mediated apoptosis in hepatoma cells

text: Hepatocellular carcinoma (HCC) is the most common liver cancer and a major cause of adult death. The current treatments for HCC suffer from drug resistance and poor prognosis; therefore, novel therapeutic agents are urgently needed. Phytochemicals have been proposed to treat a range of cancers. Among them, α-lipoic acid (α-LA), a naturally synthesized antioxidant found in various dietary animal and plant sources, prevents oxidant-mediated cell death in normal cells while inducing apoptosis in several cancer cell lines. Previously, we demonstrated that the treatment of hepatoma cells with α-LA induced apoptosis, which was preceded by the generation of reactive oxygen species (ROS) and activation of the p53 protein, a known inducer of mitochondria-mediated apoptosis. Several studies have shown that ROS-induced apoptosis is associated with endoplasmic reticulum (ER) stress and Unfolded Protein Response (UPR) activation. Herein, we investigated if α-LA-induced apoptosis in hepatoma cell lines was ER stress- and UPR-mediated by gene expression profiling analyses. UPR and ER stress pathways were the most up-regulated after treatment with α-LA. This finding, which has been confirmed by expression analyses of ER- and UPR-associated proteins, provides a better understanding of the molecular mechanisms behind the anti-tumoral action of α-LA on hepatoma cells.


title: ARIANN: Low-Interaction Privacy-Preserving Deep Learning via Function Secret Sharing

text: We propose ARIANN, a low-interaction framework to perform private training and inference of standard deep neural networks on sensitive data. This framework implements semi-honest 2-party computation and leverages function secret sharing, a recent cryptographic protocol that only uses lightweight primitives to achieve an efficient online phase with a single message of the size of the inputs, for operations like comparison and multiplication which are building blocks of neural networks. Built on top of PyTorch, it offers a wide range of functions including ReLU, MaxPool and BatchNorm, and allows to use models like AlexNet or ResNet18. We report experimental results for inference and training over distant servers. Last, we propose an extension to support n-party private federated learning.


title: Telehealth Is a Sustainable Population Health Strategy to Lower Costs and Increase Quality of Health Care in Rural Utah

text: PURPOSE: A telehealth oncology practice was created to care for patients in rural communities to improve access to health care, decrease financial burdens, and save time. PATIENTS AND METHODS: Patients with cancer at Sevier Valley Hospital in Richfield, Utah, were treated with a real-time video-based telehealth program under the care of an oncologist at a tertiary medical center. Data on financial savings, travel hours, mileage avoided, carbon emissions reduced, and revenue retained by Sevier Valley Hospital were collected from 2015 to 2018. RESULTS: From 2015 to 2018, 119 patients with cancer in Richfield, Utah, were treated with telehealth for oncology visits, accounting for 1,025 patient encounters. On average, patients saved 4 hours and 40 minutes and 332 miles roundtrip per encounter. In total, patients' savings were estimated to be $333,074. Carbon emissions were reduced by approximately 150,000 kg. Of new patient referrals, 59% were for solid tumors (70 of 119 referrals; 42 metastatic and 28 nonmetastatic cancers), and 41% were hematology consultations (49 of 119 referrals; 28 classical and 21 malignant hematologic conditions). We estimate that Sevier Valley Hospital retained $3,605,500 in revenue over this 4-year period. CONCLUSION: Using a telehealth program in rural Utah, patients with cancer benefited from substantial time and monetary savings. The local medical center was able to retain revenue it would have otherwise lost to outsourcing cancer care. Recent regulatory changes to address the COVID-19 pandemic should increase the number of patients with cancer treated via telehealth nationwide.


title: Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease

text: PURPOSE: To report the ocular characteristics and the presence of viral RNA of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in conjunctival swab specimens in a patient with confirmed 2019 novel coronavirus disease (COVID-19). PARTICIPANT AND METHODS: A 30-year-old man with confirmed COVID-19 and bilateral acute conjunctivitis which occurred 13 days after illness onset. Based on detailed ophthalmic examination, reverse transcription PCR (RT-PCR) was performed to detect SARS-CoV-2 virus in conjunctival swabs. The ocular characteristics, presence of viral RNA and viral dynamics of SARS-CoV-2 in the conjunctival specimens were evaluated. RESULTS: Slit lamp examination showed bilateral acute follicular conjunctivitis. RT-PCR assay demonstrated the presence of viral RNA in conjunctival specimen 13 days after onset (cycle threshold value: 31). The conjunctival swab specimens remained positive for SARS-CoV-2 on 14 and 17 days after onset. On day 19, RT-PCR result was negative for SARS-CoV-2. CONCLUSION: SARS-CoV-2 is capable of causing ocular complications such as viral conjunctivitis in the middle phase of illness. Precautionary measures are recommended when examining infected patients throughout the clinical course of the infection. However, conjunctival sampling might not be useful for early diagnosis because the virus may not appear initially in the conjunctiva.


title: Insights into SARS-CoV-2, the Coronavirus Underlying COVID-19: Recent Genomic Data and the Development of Reverse Genetics Systems

text: The emergence and rapid worldwide spread of a novel pandemic of acute respiratory disease - eventually named coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO) - across the human population has raised great concerns. It prompted a mobilization around the globe to study the underlying pathogen, a close relative of severe acute respiratory syndrome coronavirus (SARS-CoV) called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Numerous genome sequences of SARS-CoV-2 are now available and in-depth analyses are advancing. These will allow detailed characterization of sequence and protein functions, including comparative studies. Care should be taken when inferring function from sequence information alone, and reverse genetics systems can be used to unequivocally identify key features. For example, the molecular markers of virulence, host range and transmissibility of SARS-CoV-2 can be compared to those of related viruses in order to shed light on the biology of this emerging pathogen. Here, we summarize some recent insights from genomic studies and strategies for reverse genetics systems to generate recombinant viruses, which will be useful to investigate viral genome properties and evolution.


title: Interactive Extractive Search over Biomedical Corpora

text: We present a system that allows life-science researchers to search a linguistically annotated corpus of scientific texts using patterns over dependency graphs, as well as using patterns over token sequences and a powerful variant of boolean keyword queries. In contrast to previous attempts to dependency-based search, we introduce a light-weight query language that does not require the user to know the details of the underlying linguistic representations, and instead to query the corpus by providing an example sentence coupled with simple markup. Search is performed at an interactive speed due to efficient linguistic graph-indexing and retrieval engine. This allows for rapid exploration, development and refinement of user queries. We demonstrate the system using example workflows over two corpora: the PubMed corpus including 14,446,243 PubMed abstracts and the CORD-19 dataset, a collection of over 45,000 research papers focused on COVID-19 research. The system is publicly available at https://allenai.github.io/spike


title: Sustaining the economy under partial lockdown: A pandemic centric approach

text: As the world fights to contain and control the spread of the Novel Coronavirus, countries are imposing severe measures from restrictions on travel and social gatherings to complete lockdowns. Lockdowns, though effective in controlling the virus spread, leaves a massive economic impact. In a country like India with 21.9 % of its population below the poverty line, lockdowns have a direct impact on the livelihood of a large part of the population. Our approach conforms to healthcare and state practices of reducing human to human contact, by optimizing the lockdown strategy. We propose resuming economic activities while keeping healthcare facilities from being overwhelmed. We model the coronavirus pandemic as SEIR dynamic model for a set of states as nodes with certain population and analyze the model output before and after complete lockdown. Social distancing that people would willingly follow, in the no lockdown situation is modeled as being influenced with the knowledge of the current number of infection by imitating Granovetter threshold model. We then provide optimal lockdown policy solutions for the duration of ten weeks using NSGA-II optimization algorithm. While there are many studies that focus on modelling the transmission of COVID-19, ours is one of the few attempts to strike a balance between number of infections and economic operations.


docid: hrmqafct

title: COVID-19 in Post-Operative Patients: Imaging Findings

text: Background: Coronavirus 2019 (COVID-19) in the post-operative period is challenging. Its clinical manifestations may have similarities to other septic, thoracic, or gastrointestinal post-surgical complications. Additionally, the post-operative period may be a time of increased risk for severe manifestations of COVID-19. We sought to evaluate the frequency of COVID-19 in a cohort of patients who had recently had operations who were undergoing imaging for acute symptoms and the role of chest computed tomography (CT) in this setting. Patients and Methods: We included all patients who had chest CT for acute symptoms in the 15 days after a surgical procedure between March 1 and 31, 2020. Results: Of 46 patients with acute post-operative symptoms requiring chest imaging, eight (17%) were ultimately diagnosed with COVID-19. Among them, five (62%) required mechanical ventilation and two (25%) died. All had abnormal chest CT with typical findings of COVID-19 in 87%. Computed tomography provided an alternate diagnosis in 53% of patients who did not have COVID-19. The average time between a COVID-19-positive chest CT and the polymerase chain reaction (PCR) confirmation was 1.2 days (range, 0-4 days). Conclusion: COVID-19 is a serious post-operative condition associated with significant morbidity and mortality. Chest CT provides prompt diagnosis of COVID-19. In centers with a high prevalence of COVID-19, chest acquisition should be included in CT scans done for acute post-operative symptoms.


Covid-19: GPs can stop health checks for over 75s and routine medicine reviews


text: GPs can stop or postpone some routine work to free them up to deal with covid-19, NHS England and NHS Improvement has said In a letter sent to GPs and commissioners Nikita Kanani, medical director for primary care, and Ed Waller, director of primary care strategy, set out a list of activities that GPs could stop doing or postpone 1 It included health checks for people over 75, which it said GPs could stop doing “if in their judgment that is not the right priority ” The letter also said that routine medical reviews could be deferred until October if necessary, “unless they can be viably conducted remotely and/or in exceptional cases in person or by home visit as per local clinical discretion ” Key medicine reviews where a patient is being regularly monitored should continue, it advised The letter added that practices’ Quality Outcomes Framework (QOF) income in 2020-21 would be protected “as necessary to respond to covid-19” and that one-off adjustments would be made for practices that earned less from QOF payments in 2019-20 than in 2018-19 as a result of covid-19 activities However, practices would be asked to consider stopping any private work they were doing to help free up capacity, the letter said


Never Give Up: Lesson learned from a severe COVID-19 patient


title: A Simple and Practical Scoring System for Radiosurgical Treatment in Patients with Brain Metastases

text: BACKGROUND: The study aimed to investigate the prognostic factors for patients with brain metastases undergoing radiosurgical treatment and to introduce a simple and practical scoring system for the prediction of survival time. METHODS: We retrospectively analyzed data for 311 patients treated with Gamma Knife radiosurgery at a single institute. The mean age at time of treatment was 60 years (range 23-86 years), and the median Karnofsky performance status (KPS) score was 90 (range 60-100). Using a new prognostic index, the prognostic index for brain metastases (PIBM), the patients were categorized into 3 groups according to the primary tumor status and KPS score. We performed survival analysis and compared the prognostic ability of the PIBM with other published indices. RESULTS: During the median follow-up duration of 8.2 months (range 0.1-109 months), the median overall survival time was 9.1 months. Stable primary tumor status (hazard ratio [HR] 0.497, 95% confidence interval [CI] 0.321-0.769, p = 0.002) and KPS score ≥90 (HR 1.407, 95% CI 1.018-1.946, p = 0.039) significantly predicted longer overall survival. The PIBM showed the lowest Akaike information criterion value and the highest integrated area under the curve value compared with other prognostic indices. CONCLUSIONS: The PIBM may be a more accurate prognostic indicator than other published indices. Although this new and practical prognostic index requires further validation in larger cohort studies, we suggest that the PIBM could be useful to predict survival time and inform appropriate management of patients with brain metastases.


To a New Normal: Surgery and COVID-19 during the Transition Phase


Kidney diseases in the time of COVID-19: major challenges to patient care


docid: rfsituum

title: Helping children cope with the COVID-19 pandemic

text: Numerous societal changes in response to the COVID-19 pandemic, such as school closings and event cancellations, have caused anxiety and fear for children and young people. There are ways to help young people cope with the current situation including establishing an open dialogue, creating a structured daily routine with a schedule with assigned roles, and using social media and video conferencing to remain socially connected.


We shouldn't worry when a virus mutates during disease outbreaks


French West Indies castaway children as a result of the COVID-19 outbreak


title: Predictors of mortality in hospitalized COVID-19 patients: A systematic review and meta-analysis

text: Mortality rates of coronavirus disease-2019 (COVID-19) continue to rise across the world. Information regarding the predictors of mortality in patients with COVID-19 remains scarce. Herein, we performed a systematic review of published articles, from 1 January to 24 April 2020, to evaluate the risk factors associated with mortality in COVID-19. Two investigators independently searched the articles and collected the data, in accordance with PRISMA guidelines. We looked for associations between mortality and patient characteristics, comorbidities, and laboratory abnormalities. A total of 14 studies documenting the outcomes of 4659 patients were included. The presence of comorbidities such as hypertension (odds ratio [OR], 2.5; 95% confidence interval [CI], 2.1-3.1; P < .00001), coronary heart disease (OR, 3.8; 95% CI, 2.1-6.9; P < .00001), and diabetes (OR, 2.0; 95% CI, 1.7-2.3; P < .00001) were associated with significantly higher risk of death amongst patients with COVID-19. Those who died, compared with those who survived, differed on multiple biomarkers on admission including elevated levels of cardiac troponin (+44.2 ng/L, 95% CI, 19.0-69.4; P = .0006); C-reactive protein (+66.3 µg/mL, 95% CI, 46.7-85.9; P < .00001); interleukin-6 (+4.6 ng/mL, 95% CI, 3.6-5.6; P < .00001); D-dimer (+4.6 µg/mL, 95% CI, 2.8-6.4; P < .00001); creatinine (+15.3 µmol/L, 95% CI, 6.2-24.3; P = .001); and alanine transaminase (+5.7 U/L, 95% CI, 2.6-8.8; P = .0003); as well as decreased levels of albumin (-3.7 g/L, 95% CI, -5.3 to -2.1; P < .00001). Individuals with underlying cardiometabolic disease and that present with evidence for acute inflammation and end-organ damage are at higher risk of mortality due to COVID-19 infection and should be managed with greater intensity.


title: Detection of feline coronavirus RNA, spike gene mutations, and feline coronavirus antigen in macrophages in aqueous humor of cats in the diagnosis of feline infectious peritonitis

text: Uveitis is common in cats, and is often a feature of feline infectious peritonitis (FIP). We evaluated 3 tools for detection of feline coronavirus (FCoV) in aqueous humor: 1) a 7b gene reverse-transcription real-time PCR (7b-RT-rtPCR) assay to detect FCoV RNA, 2) a spike gene mutation RT-rtPCR (S-RT-rtPCR) assay to detect 2 point mutations in the spike gene of FCoV in cats positive by 7b-RT-rtPCR, and 3) immunocytochemistry (ICC) for detection of FCoV antigen in aqueous humor macrophages. We studied 58 cats, including 31 cats with FIP and 27 control cats. FIP was excluded by postmortem examination and negative immunohistochemistry (IHC). Aqueous humor samples obtained postmortem were assessed using 7b-RT-rtPCR in all cats, and positive samples were evaluated with S-RT-rtPCR. ICC evaluation of aqueous humor samples from 36 of the 58 cats was done using an avidin-biotin complex method and monoclonal anti-FCoV IgG 2A. Sensitivity, specificity, and negative and positive predictive values were calculated including 95% CIs. 7b-RT-rtPCR had a specificity of 100.0% (95% CI: 87.2-100.0) and sensitivity of 35.5% (95% CI: 19.2-54.6). Specificity of S-RT-rtPCR could not be determined because there were no FCoV 7b-RT-rtPCR-positive samples in the control group. Sensitivity of S-RT-rtPCR was 12.9% (95% CI 3.6-29.8). Sensitivity and specificity of ICC were 62.5% (95% CI: 40.6-81.2) and 80.0% (95% CI: 44.4-97.5), respectively. The combination of 7b-RT-rtPCR and IHC could be useful in diagnosing FIP; S-RT-rtPCR did not add value; and ICC of aqueous humor samples cannot be recommended for the diagnosis of FIP.


Existence of SARS-CoV-2 in Wastewater: Implications for Its Environmental Transmission in Developing Communities


title: The Challenges of Vaccine Development against a New Virus during a Pandemic

text: The rapid emergence of a highly pathogenic, readily transmissible coronavirus has resulted in a global pandemic, affecting millions and destabilizing economies. This catastrophe triggered a clarion call for the immediate deployment of a protective vaccine. We describe the unique challenges of developing a vaccine against SARS-CoV-2 in a pandemic setting.


Editorial. Impact of COVID-19 on neurosurgery resident research training


Interleukin-1 blockade with anakinra in acute leukaemia patients with severe COVID-19 pneumonia appears safe and may result in clinical improvement


Love at the time of the Covid-19 pandemic: preliminary results of an online survey conducted during the quarantine in Italy


The looming pandemic of COVID-19: What therapeutic options do we have now?


title: The Role of Adipocytes and Adipocyte-Like Cells in the Severity of COVID-19 Infections

text: Coronavirus disease-2019 (COVID-19), caused by the highly pathogenic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), demonstrates high morbidity and mortality caused by development of a severe acute respiratory syndrome connected with extensive pulmonary fibrosis. In this Perspective, we argue that adipocytes and adipocyte-like cells, such as pulmonary lipofibroblasts, may play an important role in the pathogenic response to SARS-CoV-2. Expression of angiotensin-converting enzyme 2 (the functional receptor for SARS-CoV) is upregulated in adipocytes of patients with obesity and diabetes, which turns adipose tissue into a potential target and viral reservoir. This may explain why obesity and diabetes are potential comorbidities for COVID-19 infections. Similar to the recently established adipocyte-myofibroblast transition, pulmonary lipofibroblasts located in the alveolar interstitium and closely related to classical adipocytes demonstrate the ability to transdifferentiate into myofibroblasts that play an integral part of pulmonary fibrosis. This may significantly increase the severity of the local response to SARS-CoV-2 in the lung. To reduce the severity and mortality associated with COVID-19, we propose to probe for the clinical response to thiazolidinediones, peroxisome proliferator activated receptor Î³ agonists that are well-known antidiabetic drugs. Thiazolidinediones are able to stabilize lipofibroblasts in their "inactive" state, preventing the transition to myofibroblasts and thereby reducing the development of pulmonary fibrosis and stimulating its resolution.


A Pneumonia Screening System based on Parasympathetic Activity Monitoring in Non-contact Way using Compact Radars Beneath the Bed Mattress


Incidence of SARS-CoV-2 vertical transmission: a meta-analysis


title: Commentary on the coronavirus pandemic: Nigeria

text: About a week after the confirmation of Nigeria's index case of COVID-19 on February 27, 2020, the Nigerian federal government set up a 12-member Presidential Task Force for the Control of the Coronavirus. The country's borders were closed on March 23, and the lockdown of cities was also implemented. The unanticipated disruption of scholarly or professional advancement for the 94% of university students who are not currently learning may increase the burden of mental illness among these students and predispose them to social vices. Two suicide deaths occurred during the lockdown. Poverty, lack of trust in the government, ignorance, denial and misplaced religious zealotry negatively impact on the behavior of Nigerians. Fear-induced behavioral changes such as consuming lemon, ginger, garlic, local herbs, and other substances for protection have also become rampant. Loss of income due to the lockdown and the accompanying destitution can also be a pathfinder for numerous other sicknesses and deaths. For the benefit of enhanced prevention and control of infection, only government-funded hospitals and a few designated privately owned hospitals have been permitted to provide continued services at this time. The number of shifts in these hospitals were adjusted such that there are fewer health care professionals in the hospital at a given time. This strategy has inhibited treatment and care for certain groups of people who are not COVID-19 patients. Efforts are being made to develop telehealth services, but most rural residents may not benefit from them. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Evaluating Postoperative Outcomes of Patients Undergoing Elective Procedures in an Ambulatory Surgery Center During the COVID-19 Pandemic

text: BACKGROUND: Despite the rapid rise of publications pertaining to COVID-19, there is a lack of data examining patient outcomes following elective procedures performed during this pandemic. OBJECTIVES: The purpose of this investigation is to: 1) examine the postoperative outcomes of patients that underwent elective procedures in an ambulatory surgery center during the COVID-19 pandemic; 2) share the preoperative screening and patient selection protocol implemented in our center. METHODS: Elective procedures performed in an ambulatory surgery center between March 1, 2020 and April 16, 2020 were retrospectively reviewed. The primary outcomes were occurrence of COVID-19 related postoperative complications. These complications include pneumonia, stroke, myocardial infarction, and clotting disorders. Predictive variables analyzed in this study were: age, American Society of Anesthesiologist (ASA) score, and specialty conducting the procedure, operating time, and the type of plastic and reconstructive surgery procedure being performed. RESULTS: A total of 300 consecutive electives cases were included in the study. The most common procedures were pain management (43.0%), gastrointestinal (26.0%), aesthetic (14.0%), orthopedic (10.3%), reconstructive (4.0%), otorhinolaryngology (2.0%), and gynecology (0.67%). The median age of the cohort was 54.6 years (range, 1-90 years) and the median procedure time was 47 minutes (range, 11-304 minutes). COVID-19 related symptoms or complications following the procedures were not observed in any of the patients nor the healthcare care personnel. CONCLUSIONS: In this cohort of 300 electives cases, we found no patients with COVID-19 related symptoms postoperatively. This suggests that with proper preoperative screening and patient selection, elective procedures can be safely performed in an ASC during this pandemic.


title: Auswirkungen von COVID-19 auf die Nuklearmedizin in Deutschland, Österreich und der Schweiz: Eine internationale Umfrage im April 2020./ Impact of COVID-19 on Nuclear Medicine in Germany, Austria and Switzerland: An International Survey in April 2020

text: INTRODUCTION: Preparations of health systems to accommodate large number of severely ill COVID-19 patients in March/April 2020 has a significant impact on nuclear medicine departments. MATERIALS AND METHODS: A web-based questionnaire was designed to differentiate the impact of the pandemic on inpatient and outpatient nuclear medicine operations and on public versus private health systems, respectively. Questions were addressing the following issues: impact on nuclear medicine diagnostics and therapy, use of recommendations, personal protective equipment, and organizational adaptations. The survey was available for 6 days and closed on April 20, 2020. RESULTS: 113 complete responses were recorded. Nearly all participants (97â%) report a decline of nuclear medicine diagnostic procedures. The mean reduction in the last three weeks for PET/CT, scintigraphies of bone, myocardium, lung thyroid, sentinel lymph-node are -14.4â%, -47.2â%, -47.5â%, -40.7â%, -58.4â%, and -25.2â% respectively. Furthermore, 76â% of the participants report a reduction in therapies especially for benign thyroid disease (-41.8â%) and radiosynoviorthesis (-53.8â%) while tumor therapies remained mainly stable. 48â% of the participants report a shortage of personal protective equipment. CONCLUSIONS: Nuclear medicine services are notably reduced 3 weeks after the SARS-CoV-2 pandemic reached Germany, Austria and Switzerland on a large scale. We must be aware that the current crisis will also have a significant economic impact on the healthcare system. As the survey cannot adapt to daily dynamic changes in priorities, it serves as a first snapshot requiring follow-up studies and comparisons with other countries and regions.


title: æ°åå ç¶ç æ¯èºçå½±åå¦æ£æ¥ã è¯æåå»é¢å ææé¢é²ä¸æ§å¶ï¼æ¹åçæ¾å°å¦ä¸å®¶å ±./ æ°åå ç¶ç æ¯èºçå½±åå¦æ£æ¥ã è¯æåå»é¢å ææé¢é²ä¸æ§å¶ï¼æ¹åçæ¾å°å¦ä¸å®¶å ±./ Imaging examination, diagnosis, and control and prevention of nosocomial infection for coronavirus disease 2019: Expert consensus of Hunan radiologist

text: The outbreak of coronavirus disease 2019 (COVID-19) is a huge threat to global public health because it develops rapidly. There is no specific treatment so far. Chest imaging examination is an important auxiliary examination method in diagnosis of COVID-19. To further standardize the imaging examination and diagnosis of COVID-19, Hunan Society of Radiology together with Imaging Technology Professional Committee of Hunan Medical Association reach an expert consensus document on imaging examination, diagnosis, and control and prevention of nosocomial infection for COVID-19. This document summarizes the epidemiological characteristics, clinical features, imaging examination procedure, imaging findings, CT staging, the value of imaging examination, and the methods for control and prevention of nosocomial infection for COVID-19 during imaging examination. Furthermore, it extends the clinical characteristics and imaging manifestations of COVID-19 in children.


What matters, most-especially now?


title: Could nasal nitric oxide help to mitigate the severity of COVID-19?

text: The nasal cavity and turbinates play important physiological functions by filtering, warming and humidifying inhaled air. Paranasal sinuses continually produce nitric oxide (NO), a reactive oxygen species that diffuses to the bronchi and lungs to produce bronchodilatory and vasodilatory effects. Studies indicate that NO may also help to reduce respiratory tract infection by inactivating viruses and inhibiting their replication in epithelial cells. In view of the pandemic caused by the novel coronavirus (SARS-CoV-2), clinical trials have been designed to examine the effects of inhaled nitric oxide in COVID-19 subjects. We discuss here additional lifestyle factors such as mouth breathing which may affect the antiviral response against SARS-CoV-2 by bypassing the filtering effect of the nose and by decreasing NO levels in the airways. Simple devices that promote nasal breathing during sleep may help prevent the common cold, suggesting potential benefits against coronavirus infection. In the absence of effective treatments against COVID-19, the alternative strategies proposed here should be considered and studied in more detail.


Considerations for the outpatient practice in pediatric surgery during the novel SARS-CoV-2 pandemic


title: Potential SARS-CoV-2 Preimmune IgM Epitopes

text: While studying the human public IgM igome as represented by a library of 224,087 linear mimotopes, three exact matches to peptides in the proteins of SARS-CoV-2 were found: two in the open reading frame 1ab and one in the spike protein. Joining the efforts to fast track SARS-CoV-2 vaccine development, here we describe briefly these potential epitopes in comparison to mimotopes representing peptides of SARS-CoV, HCoV 229E and OC43.


Prevalence of Anxiety and Associated Factors for Chinese Adolescents during the COVID-19 Outbreak


title: Spontaneous pneumomediastinum occurring in the SARS-COV-2 infection

text: We report the case of a 23 year old female admitted for management of infection by the SARS-COV-2. The chest CT found a spontaneous pneumomediastinum that resorbed over 7 days with a good clinical outcome. We will discuss the mechanism underlying the occurrence of spontaneous pneumomediastinum during a COVID-19 pneumonia.


Reply to Re: COVID-19 and the Urology Match: Perspectives and a Call to Action


title: Why lockdown of the elderly is not ageist and why levelling down equality is wrong

text: In order to prevent the rapid spread of COVID-19, governments have placed significant restrictions on liberty, including preventing all non-essential travel. These restrictions were justified on the basis the health system may be overwhelmed by COVID-19 cases and in order to prevent deaths. Governments are now considering how they may de-escalate these restrictions. This article argues that an appropriate approach may be to lift the general lockdown but implement selective isolation of the elderly. While this discriminates against the elderly, there is a morally relevant difference-the elderly are far more likely to require hospitalisation and die than the rest of the population. If the aim is to ensure the health system is not overwhelmed and to reduce the death rate, preventing the elderly from contracting the virus may be an effective means of achieving this. The alternative is to continue to keep everyone in lockdown. It is argued that this is levelling down equality and is unethical. It suggests that in order for the elderly to avoid contracting the virus, the whole population should have their liberty deprived, even though the same result could be achieved by only restricting the liberty of the elderly. Similar arguments may also be applied to all groups at increased risk of COVID-19, such as men and those with comorbidities, the obese and people from ethnic minorities or socially deprived groups. This utilitarian concern must be balanced against other considerations, such as equality and justice, and the benefits gained from discriminating in these ways must be proportionately greater than the negative consequences of doing so. Such selective discrimination will be most justified when the liberty restriction to a group promotes the well-being of that group (apart from its wider social benefits).


title: The Burden of COVID-19 in People Living with HIV: A Syndemic Perspective

text: The emergence of the novel coronavirus disease known as COVID-19 creates another health burden for people living with HIV (PLWH) who face multiple morbidities and may be at heightened risk for severe physical health illness from COVID-19. Our abilities to address these morbidities in PLWH must be considered alongside the socially-produced burdens that both place this population at risk for COVID-19 and heighten the likelihood of adverse outcomes. These burdens can affect the physical, emotional, and social well-being of PLWH and interfere with the delivery of effective healthcare and access to HIV treatment. We posit that a syndemic framework can be used to conceptualize the potential impact of COVID-19 among PLWH to inform the development of health programming services.


title: [Clinical features and chest CT findings of coronavirus disease 2019 in infants and young children]

text: OBJECTIVE: To study the clinical features and chest CT findings of coronavirus disease 2019 (COVID-19) in infants and young children. METHODS: A retrospective analysis was performed for the clinical data and chest CT images of 9 children, aged 0 to 3 years, who were diagnosed with COVID-19 by nucleic acid detection between January 20 and February 10, 2020. RESULTS: All 9 children had an epidemiological history, and family clustering was observed for all infected children. Among the 9 children with COVID-19, 5 had no symptoms, 4 had fever, 2 had cough, and 1 had rhinorrhea. There were only symptoms of the respiratory system. Laboratory examination showed no reductions in leukocyte or lymphocyte count. Among the 9 children, 6 had an increase in lymphocyte count and 2 had an increase in leukocyte count. CT examination showed that among the 9 children, 8 had pulmonary inflammation located below the pleura or near the interlobar fissure and 3 had lesions distributed along the bronchovascular bundles. As for the morphology of the lesions, 6 had nodular lesions and 7 had patchy lesions; ground glass opacity with consolidation was observed in 6 children, among whom 3 had halo sign, and there was no typical paving stone sign. CONCLUSIONS: Infants and young children with COVID-19 tend to have mild clinical symptoms and imaging findings not as typical as those of adults, and therefore, the diagnosis of COVID-19 should be made based on imaging findings along with epidemiological history and nucleic acid detection. Chest CT has guiding significance for the early diagnosis of asymptomatic children.


COVID-19, equipoise and observational studies: a reminder of forgotten issues


title: Admission of patients with STEMI since the outbreak of the COVID-19 pandemic. A survey by the European Society of Cardiology

text: The paper describes the results of an ESC Covid survey.


Key words to be adopted for COVID-19 research


title: [Psychopathological symptoms during Covid-19 quarantine in spanish general population: a preliminary analysis based on sociodemographic and occupational-contextual factors.]

text: OBJECTIVE: Coronavirus (COVID-19) pandemic disease forced different countries to adopt quarantine measures These actions could have an impact on mental health in the general population The objective of this study was to analyze the differences in psychopathological symptoms shown by Spanish general population during the COVID-19 quarantine based on sociodemographic, occupational and environmental-contextual variables METHODS: A cross-sectional pilot study was performed in a sample of 151 participants aged between 18-76 years old The Symptom Assessment-45 Questionnaire via online was used to measure the severity of psychopathology symptoms Socio-demographic, environmental and occupational variables were collected with an ad hoc questionnaire The data were gathered from the 3rd to the 6th of April, 2020 A descriptive and comparative analysis was carried out using parametric contrasts (t test and ANOVA) RESULTS: The younger participants (18-35 years) showed higher levels of hostility (t=2 24;p=0 02), depression (t=2 56;p=0 01), anxiety (t=2 78;p=0 006) and interpersonal sensitivity (t=2 08;p=0 04) than older participants (36-76 years) The active or employed people presented lower values of depressive symptoms (t=2 10;p=0 04) than unemployed people The participants who dedicate less than 30 minutes on getting informed about COVID-19 showed higher scores for hostility (t=2 36;p=0 02) and interpersonal sensitivity (t=1 98;p=0 04) than participants who indicated dedicating at least 30 minutes People who played sport daily reported a lower level of somatization symptoms (t=-2 11;p=0 03) than persons that did not play sport Those who had relatives, acquaintances, etc with COVID-19 reported higher levels of anxiety (t=2 09;p=0 04) than those who did not have close people infected Lastly, participants who lived alone showed a higher level of psychoticism (F=3 93;p=0 02) compared to those who lived with more than two people CONCLUSIONS: The findings of this study show that during quarantine can be identified groups with higher psychological vulnerability based on sociodemographic and occupational-contextual factors


title: Psychopathological symptoms during Covid-19 quarantine in spanish general population: a preliminary analysis based on sociodemographic and occupational-contextual factors./ Sintomas psicopatologicos durante la cuarentena por Covid-19 en poblacion gen

text: OBJECTIVE: Coronavirus (COVID-19) pandemic disease forced different countries to adopt quarantine measures These actions could have an impact on mental health in the general population The objective of this study was to analyze the differences in psychopathological symptoms shown by Spanish general population during the COVID-19 quarantine based on sociodemographic, occupational and environmental-contextual variables METHODS: A cross-sectional pilot study was performed in a sample of 151 participants aged between 18-76 years old The Symptom Assessment-45 Questionnaire via online was used to measure the severity of psychopathology symptoms Socio-demographic, environmental and occupational variables were collected with an ad hoc questionnaire The data were gathered from the 3rd to the 6th of April, 2020 A descriptive and comparative analysis was carried out using parametric contrasts (t test and ANOVA) RESULTS: The younger participants (18-35 years) showed higher levels of hostility (t=2 24;p=0 02), depression (t=2 56;p=0 01), anxiety (t=2 78;p=0 006) and interpersonal sensitivity (t=2 08;p=0 04) than older participants (36-76 years) The active or employed people presented lower values of depressive symptoms (t=2 10;p=0 04) than unemployed people The participants who dedicate less than 30 minutes on getting informed about COVID-19 showed higher scores for hostility (t=2 36;p=0 02) and interpersonal sensitivity (t=1 98;p=0 04) than participants who indicated dedicating at least 30 minutes People who played sport daily reported a lower level of somatization symptoms (t=-2 11;p=0 03) than persons that did not play sport Those who had relatives, acquaintances, etc with COVID-19 reported higher levels of anxiety (t=2 09;p=0 04) than those who did not have close people infected Lastly, participants who lived alone showed a higher level of psychoticism (F=3 93;p=0 02) compared to those who lived with more than two people CONCLUSIONS: The findings of this study show that during quarantine can be identified groups with higher psychological vulnerability based on sociodemographic and occupational-contextual factors OBJETIVO: La enfermedad pandemica por coronavirus (COVID-19) ha hecho necesaria la adopcion de medidas de cuarentena en diferentes paises Estas medidas podrian tener un impacto sobre la salud mental de la poblacion general en confinamiento El objetivo del trabajo fue analizar las diferencias en la sintomatologia psicopatologica mostrada por la poblacion general espanola durante la cuarentena por COVID-19 en funcion de variables sociodemograficas, ambientales y ocupacionales METODOS: Se realizo un estudio trasversal en una muestra de 151 participantes, con edades comprendidas entre los 18 y los 76 anos, en el que se utilizo de forma online la version espanola del Symptom Assessment-45 Questionnaire para medir el nivel de sintomas psicopatologicos Se recogieron tambien variables sociodemograficas, ambientales y de ocupacion (mediante una encuesta ad hoc) La informacion fue recogida del 3 al 6 abril de 2020 Se realizo un analisis descriptivo y comparativo utilizando contrastes parametricos (prueba t y ANOVA) RESULTADOS: Los participantes mas jovenes (18-35 anos) mostraron niveles mas altos de hostilidad (t=2,24;p=0,02), depresion (t=2,56;p=0,01), ansiedad (t=2,78;p=0,006) y sensibilidad interpersonal (t=2,08;p=0,04) que los participantes mayores (36-76 anos) Las personas activas o empleadas presentaron valores mas bajos de sintomas depresivos (t=2,10;p=0,04) que las personas desempleadas Los participantes que dedicaron menos de 30 minutos a informarse sobre el COVID-19 mostraron puntuaciones mas altas en hostilidad (t=2,36;p=0,02) y sensibilidad interpersonal (t=1,98;p=0,04) que los participantes que indicaron dedicar al menos 30 minutos Las personas que practicaban deporte diariamente informaron de un menor nivel de sintomas de somatizacion (t=-2,11;p=0,03) que las personas que no practicaban deporte Aquellos que tenian familiares, conocidos, etc con COVID-19 informaron de niveles mas altos de ansiedad (t=2,09;p=0,04) que aquellos que no tenian a personas cercanas infectadas Por ultimo, los participantes que vivian solos mostraron un mayor nivel de psicoticismo (F=3,93;p=0,02) en comparacion con aquellos que vivian con mas de dos personas CONCLUSIONES: Los resultados de este estudio muestran que durante la cuarentena se pueden identificar grupos con mayor vulnerabilidad psicologica en funcion de factores sociodemograficos y ocupacionales-contextuales


HIV vaccine failure, coronavirus papers and an unprecedented glimpse of the Sun


title: Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis

text: BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak is evolving rapidly worldwide. OBJECTIVE: To evaluate the risk of serious adverse outcomes in patients with COVID-19 by stratifying the comorbidity status. METHODS: We analysed data from 1590 laboratory confirmed hospitalised patients from 575 hospitals in 31 provinces/autonomous regions/provincial municipalities across mainland China between 11 December 2019 and 31 January 2020. We analysed the composite end-points, which consisted of admission to an intensive care unit, invasive ventilation or death. The risk of reaching the composite end-points was compared according to the presence and number of comorbidities. RESULTS: The mean age was 48.9â years and 686 (42.7%) patients were female. Severe cases accounted for 16.0% of the study population. 131 (8.2%) patients reached the composite end-points. 399 (25.1%) reported having at least one comorbidity. The most prevalent comorbidity was hypertension (16.9%), followed by diabetes (8.2%). 130 (8.2%) patients reported having two or more comorbidities. After adjusting for age and smoking status, COPD (HR (95% CI) 2.681 (1.424-5.048)), diabetes (1.59 (1.03-2.45)), hypertension (1.58 (1.07-2.32)) and malignancy (3.50 (1.60-7.64)) were risk factors of reaching the composite end-points. The hazard ratio (95% CI) was 1.79 (1.16-2.77) among patients with at least one comorbidity and 2.59 (1.61-4.17) among patients with two or more comorbidities. CONCLUSION: Among laboratory confirmed cases of COVID-19, patients with any comorbidity yielded poorer clinical outcomes than those without. A greater number of comorbidities also correlated with poorer clinical outcomes.


Integrated Hospital Quarantine System against COVID-19


Do novel drugs for diabetes help in COVID-19? Another brick in the wall?


Increased Number of Submacular Hemorrhages As a Consequence of COVID-19 Lockdown


Correction to Lancet Infect Dis 2019; 20: 275-76


title: Current Drugs with Potential for Treatment of COVID-19: A Literature Review

text: PURPOSE: SARS-CoV-2 first emerged in China in December 2019 and rapidly spread worldwide. No vaccine or approved drug is available to eradicate the virus, however, some drugs that are indicated for other afflictions seems to be potentially beneficial to treat the infection albeit without unequivocal evidence. The aim of this article is to review the published background on the effectiveness of these drugs against COVID-19 Methods: A thorough literature search was conducted on recently published studies which have published between January 1 to March 25, 2020. PubMed, Google Scholar and Science Direct databases were searched Results: A total 22 articles were found eligible. 8 discuss about treatment outcomes from their applied drugs during treatment of COVID-19 patients, 4 report laboratory tests, one report animal trial and other 9 articles discuss recommendations and suggestions based on the treatment process and clinical outcomes of other diseases such as malaria, ebola, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The data and/or recommendations are categorized in 4 classes: (a) anti-viral and anti-inflammatory drugs, (b) anti-malaria drugs, (c) traditional Chinese drugs and (d) other treatments/drugs. CONCLUSION: All examined treatments, although potentiality effective against COVID-19, need either appropriate drug development or clinical trial to be suitable for clinical use.


Suspend tests and rankings


title: Is it Kawasaki shock syndrome, Kawasaki-like disease or pediatric inflammatory multisystem disease? The importance of semantic in the era of COVID-19 pandemic

text: A few weeks after the peak of the global 2019 novel coronavirus disease pandemic, cases of shock, multisystem inflammation and severe myocarditis have occurred in children and adolescents, generating some concerns and above all many questions. An almost immediate association raised with shock syndrome related to Kawasaki disease (KD). However, in light of bo/th experience and literature have taught us about severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection, and what already known on the epidemiology of KD, we suggest here the hypothesis of a new 'post-viral' systemic inflammatory disease related to excessive adaptive immune response rather than a form of KD caused by SARS-COV-2. We discuss analogies and differences between the two forms.


COVID-19 as a cause of immune thrombocytopenia


COVID-19 and congenital heart disease in perspective


Covid-19: Mercedes F1 to provide breathing aid as alternative to ventilator


The Disproportionate Burden of COVID-19 for Immigrants in the Bronx, New York


title: Commentary on the management of total laryngectomy patients during the COVID-19 pandemic

text: The coronavirus disease-2019 (COVID-19) pandemic has rapidly spread across the world, placing unprecedented strain on the health care system. Health care resources including hospital beds, ICUs, as well as personal protective equipment are becoming increasingly rationed and scare commodities. In this environment, the laryngectomee (patient having previously undergone a total laryngectomy) continues to represent a unique patient with unique needs. Given their surgically altered airway, they pose a challenge to manage for the otolaryngologist within the current COVID-19 pandemic. In this brief report, we present special considerations and best practice recommendations in the management of total laryngectomy patients. We also discuss recommendations for laryngectomy patients and minimizing community exposures.


title: Heterogeneous Response to First-Generation Tyrosine Kinase Inhibitors in Non-Small-Cell Lung Cancers with Different EGFR Exon 19 Mutations

text: BACKGROUND: Epidermal growth factor receptor (EGFR) exon 19 deletions (19dels) appear in a large number of variants, which has not been distinguished in previously published trials despite differences in deletion and insertion locations. OBJECTIVE: The aim of this study was to investigate the therapeutic response of patients with different EGFR exon 19dels to first-generation tyrosine kinase inhibitors (TKIs) and the mechanisms by which their tumors acquire resistance to these TKIs. PATIENTS AND METHODS: The clinical outcomes of 195 patients harboring EGFR exon 19dels and receiving first-generation EGFR TKIs between July 2011 and June 2019 were retrospectively analyzed. RESULTS: A total of twenty EGFR exon 19dels variants were identified. The patients were divided into three groups according to the first residue of the deletion, including E746, L747, and other residues (T751 or S752). The median progression-free survival (PFS) of patients treated with EGFR TKIs was significantly different between groups (p < 0.001). Patients harboring EGFR exon 19dels starting at T751 or S752 had the shortest median PFS (2.9 months), followed by those with E746 (11.4 months) and those with L747 (17.2 months). Analyzing 140 patients who had progressed on therapy, EGFR exon 19dels beginning at T751 or S752 were associated with a low incidence of the T790M mutation (16.7%). CONCLUSIONS: Deletion location and type variants (with or without an insertion and/or a substitution) might affect first-generation TKI efficacy, and different EGFR exon 19dels should be considered when making decisions on which EGFR TKI should be used.


Covid-19: England must aim for "zero tolerance" to avoid 27 000 predicted deaths, experts say


Therapeutic options for the treatment of 2019-novel coronavirus: An evidence-based approach


title: Neutrophil-to-lymphocyte ratio as a predictive biomarker for moderate-severe ARDS in severe COVID-19 patients

text: TRIAL REGISTRATION: ChiCTR, ChiCTR2000029758. Registered 12 February 2020 - Retrospectively registered.


Resource-sparing urgent endoscopies by a mobile on-call team in the Paris area during the COVID-19 outbreak


Medical Student Development of K-12 Educational Resources During the COVID-19 Pandemic


docid: zjhyqpla

title: Changes in emergency service access after spread of COVID-19 across Italy


title: Dental radiographic procedures during COVID-19 outbreak and normalization period: recommendations on infection control

text: Dental professionals have always been meticulous about infection control due to high risk of cross-contamination during dental procedures. Nevertheless, there is an urgent need to review and revise our current practice of infection control and develop more strict protocols that will prevent nosocomial spread of infection during COVID-19 outbreak and future pandemics. The risk of contamination is high during dental radiography if proper disinfection techniques are not applied. This document provides advice and guidance for infection control when practicing dental radiography during COVID-19 pandemic.


title: Current treatment approaches for COVID-19 and the clinical value of transfusion-related technologies

text: COVID-19 is caused by SARS-CoV-2 which is a new enveloped virus that belongs to the Beta coronavirus genus. As a major health crisis, SARS-CoV-2 has infected over a million people around the world. There is currently no specific treatment available for patients with COVID-19 infection. Numerous potential therapies, including supportive intervention, immunomodulatory agents, antiviral therapy, and convalescent plasma transfusion, have been used in clinical practice. Herein, we summarize the current potential therapeutic approaches for diseases related to COVID-19 infection and discusses the clinical value of blood transfusion-related technologies used in COVID-19 treatment.


title: Presentation of new onset anosmia during the COVID-19 pandemic

text: INTRODUCTION: Anosmia has not been formally recognised as a symptom of COVID-19 infection. Growing anecdotal evidence suggests increasing incidence of cases of anosmia during the current pandemic, suggesting that COVID-19 may cause olfactory dysfunction. The objective was to characterise patients reporting new onset anosmia during the COVID-19 pandemic METHODOLOGY: Design: Survey of 2428 patients reporting new onset anosmia during the COVID-19 pandemic. SETTING: Volunteer sample of patients seeking medical advice of recent onset self-diagnosed loss of sense of smell RESULTS: 2428 surveys were completed within 7 days; 64% respondents were under 40. The majority of respondents reported onset of their anosmia in the last week. Of the cohort, 17% did not report any other symptom thought to be associated with COVID-19. In patients who reported other symptoms, 51% reported either cough or fever and therefore met current guidelines for self-isolation. CONCLUSIONS: Anosmia is reported in conjunction with well-reported symptoms of coronas virus, but 1 in 6 patients with recent onset anosmia report this as an isolated symptom. This might help identify otherwise asymptomatic carriers of disease and trigger targeted testing. Further study with COVID-19 testing is required to identify the proportion of patients in whom new onset anosmia can be attributed to COVID-19.


Personal reflections of an emergency general surgeon on the COVID-19 pandemic


title: Ultra-sensitive and high-throughput CRISPR-p owered COVID-19 diagnosis

text: Recent research suggests that SARS-CoV-2-infected individuals can be highly infectious while asymptomatic or pre-symptomatic, and that an infected person may infect 5.6 other individuals on average. This situation highlights the need for rapid, sensitive SARS-CoV-2 diagnostic assays capable of high-throughput operation that can preferably utilize existing equipment to facilitate broad, large-scale screening efforts. We have developed a CRISPR-based assay that can meet all these criteria. This assay utilizes a custom CRISPR Cas12a/gRNA complex and a fluorescent probe to detect target amplicons produced by standard RT-PCR or isothermal recombinase polymerase amplification (RPA), to allow sensitive detection at sites not equipped with real-time PCR systems required for qPCR diagnostics. We found this approach allowed sensitive and robust detection of SARS-CoV-2 positive samples, with a sample-to-answer time of ~50 min, and a limit of detection of 2 copies per sample. CRISPR assay diagnostic results obtained nasal swab samples of individuals with suspected COVID-19 cases were comparable to paired results from a CDC-approved quantitative RT-PCR (RT-qPCR) assay performed in a state testing lab, and superior to those produced by same assay in a clinical lab, where the RT-qPCR assay exhibited multiple invalid or inconclusive results. Our assay also demonstrated greater analytical sensitivity and more robust diagnostic performance than other recently reported CRISPR-based assays. Based on these findings, we believe that a CRISPR-based fluorescent application has potential to improve current COVID-19 screening efforts.


Chloroquine and Hydroxychloroquine in the Era of SARS - CoV2: Caution on Their Cardiac Toxicity


title: Organising a Successful AI Online Conference: Lessons from SoCS 2020

text: The 13th Symposium on Combinatorial Search (SoCS) was held May 26-28, 2020. Originally scheduled to take place in Vienna, Austria, the symposium pivoted toward a fully online technical program in early March. As an in-person event SoCS offers participants a diverse array of scholarly activities including technical talks (long and short), poster sessions, plenary sessions, a community meeting and, new for 2020, a Master Class tutorial program. This paper describes challenges, approaches and opportunities associated with adapting these many different activities to the online setting. We consider issues such as scheduling, dissemination, attendee interaction and community engagement before, during and after the event. We report on the approaches taken by SoCS in each case, we give a post-hoc analysis of their their effectiveness and we discuss how these decisions continue to impact the SoCS community in the days after SoCS 2020.


Pour un renfort vétérinaire au diagnostic du Covid-19


title: How to strengthen a health research system: WHO's review, whose literature and who is providing leadership?

text: BACKGROUND: Health research is important for the achievement of the Sustainable Development Goals. However, there are many challenges facing health research, including securing sufficient funds, building capacity, producing research findings and using both local and global evidence, and avoiding waste. A WHO initiative addressed these challenges by developing a conceptual framework with four functions to guide the development of national health research systems. Despite some progress, more is needed before health research systems can meet their full potential of improving health systems. The WHO Regional Office for Europe commissioned an evidence synthesis of the systems-level literature. This Opinion piece considers its findings before reflecting on the vast additional literature available on the range of specific health research system functions related to the various challenges. Finally, it considers who should lead research system strengthening. MAIN TEXT: The evidence synthesis identifies two main approaches for strengthening national health research systems, namely implementing comprehensive and coherent strategies and participation in partnerships. The literature describing these approaches at the systems level also provides data on ways to strengthen each of the four functions of governance, securing financing, capacity-building, and production and use of research. Countries effectively implementing strategies include England, Ireland and Rwanda, whereas West Africa experienced effective partnerships. Recommended policy approaches for system strengthening are context specific. The vast literature on each function and the ever-growing evidence-base are illustrated by considering papers in just one key journal, Health Research Policy and Systems, and analysing the contribution of two national studies. A review of the functions of the Iranian system identifies over 200 relevant and mostly national records; an analysis of the creation of the English National Institute for Health Research describes the key leadership role played by the health department. Furthermore, WHO is playing leadership roles in helping coordinate partnerships within and across health research systems that have been attempting to tackle the COVID-19 crisis. CONCLUSIONS: The evidence synthesis provides a firm basis for decision-making by policy-makers and research leaders looking to strengthen national health research systems within their own national context. It identifies five crucial policy approaches - conducting situation analysis, sustaining a comprehensive strategy, engaging stakeholders, evaluating impacts on health systems, and partnership participation. The vast and ever-growing additional literature could provide further perspectives, including on crucial leadership roles for health ministries.


Covid-19: Doctors still at "considerable risk" from lack of PPE, BMA warns


title: The end of social confinement and COVID-19 re-emergence risk

text: The lack of effective pharmaceutical interventions for SARS-CoV-2 raises the possibility of COVID-19 recurrence. We explore different post-confinement scenarios by using a stochastic modified SEIR (susceptible-exposed-infectious-recovered) model that accounts for the spread of infection during the latent period and also incorporates time-decaying effects due to potential loss of acquired immunity, people's increasing awareness of social distancing and the use of non-pharmaceutical interventions. Our results suggest that lockdowns should remain in place for at least 60 days to prevent epidemic growth, as well as a potentially larger second wave of SARS-CoV-2 cases occurring within months. The best-case scenario should also gradually incorporate workers in a daily proportion at most 50% higher than during the confinement period. We show that decaying immunity and particularly awareness and behaviour have 99% significant effects on both the current wave of infection and on preventing COVID-19 re-emergence. Social distancing and individual non-pharmaceutical interventions could potentially remove the need for lockdowns.


Evaluating intubation boxes for airway management


Letter to the Editor: Coronavirus Disease 2019 and Resilience: Neurosurgical Perspectives


Multiple organ dysfunction in SARS-CoV-2: MODS-CoV-2


Novel Coronavirus: What Neuroradiologists Should Do


Akutt lungesviktsyndrom hos covid-19-pasient med negative nasofarynksprøver./ Akutt lungesviktsyndrom hos covid-19-pasient med negative nasofarynksprøver./ Acute respiratory distress syndrome in a patient with COVID-19 and negative nasopharyngeal swabs


title: Deep reinforcement learning for large-scale epidemic control

text: Epidemics of infectious diseases are an important threat to public health and global economies. Yet, the development of prevention strategies remains a challenging process, as epidemics are non-linear and complex processes. For this reason, we investigate a deep reinforcement learning approach to automatically learn prevention strategies in the context of pandemic influenza. Firstly, we construct a new epidemiological meta-population model, with 379 patches (one for each administrative district in Great Britain), that adequately captures the infection process of pandemic influenza. Our model balances complexity and computational efficiency such that the use of reinforcement learning techniques becomes attainable. Secondly, we set up a ground truth such that we can evaluate the performance of the 'Proximal Policy Optimization' algorithm to learn in a single district of this epidemiological model. Finally, we consider a large-scale problem, by conducting an experiment where we aim to learn a joint policy to control the districts in a community of 11 tightly coupled districts, for which no ground truth can be established. This experiment shows that deep reinforcement learning can be used to learn mitigation policies in complex epidemiological models with a large state space. Moreover, through this experiment, we demonstrate that there can be an advantage to consider collaboration between districts when designing prevention strategies.


title: Evidence based management guideline for the COVID-19 pandemic - Review article

text: COVID-19 has now been declared a pandemic. To date, COVID-19 has affected over 2.5 million people worldwide, resulting in over 170,000 reported deaths. Numerous preventative strategies and non-pharmaceutical interventions have been employed to mitigate the spread of disease including careful infection control, the isolation of patients, and social distancing. Management is predominantly focused on the provision of supportive care, with oxygen therapy representing the major treatment intervention. Medical therapy involving corticosteroids and antivirals have also been encouraged as part of critical management schemes. However, there is at present no specific antiviral recommended for the treatment of COVID-19, and no vaccine is currently available. Despite the strategic implementation of these measures, the number of new reported cases continues to rise at a profoundly alarming rate. As new findings emerge, there is an urgent need for up-to-date management guidelines. In response to this call, we review what is currently known regarding the management of COVID-19, and offer an evidence-based review of current practice.


title: Cancer management challenge in a developing country in COVID-19 pandemic: reflection of a group of Moroccan oncologists

text: Management of cancer patients during the COVID-19 pandemic is a worldwide challenge - in particular in developing countries where the risk of saturation of health facilities and intensive care beds must be minimized. The first case of COVID-19 was declared in Morocco on 2 March 2020, after which a panel of Moroccan experts, consisting of medical oncologists from universities and regional and private oncology centers, was promptly assembled to conduct a group reflection on cancer patient's management. The main objective is to protect the immunocompromised population from the risk of COVID-19, while maintaining an adequate management of cancer, which can quickly compromise their prognosis. Recommendations are provided according to each clinical situation: patients undergoing treatment, new cases, hospitalized patients, palliative care and surveillance.


Factors involved in low susceptibility to COVID-19: An adaptation of high altitude inhabitants


First paediatric COVID-19 associated death in Italy


title: Could BCG Vaccination Induce Protective Trained Immunity for SARS-CoV-2?

text: Trained immunity is a type of non-specific memory-like immune response induced by some pathogens and vaccines, such as BCG, which can confer antigen-independent protection against a wide variety of pathogens. The BCG vaccine has been extensively used to protect against tuberculosis for almost a 100 years. Interestingly, this vaccine reduces children's mortality caused by infections unrelated to Mycobacterium tuberculosis infection, a phenomenon thought to be due to the induction of trained immunity. The SARS-CoV-2 pandemic has infected, as of April 22, 2020, 2,623,231 people globally, causing a major public health problem worldwide. Currently, no vaccine or treatment is available to control this pandemic. We analyzed the number of positive cases and deaths in different countries and correlated them with the inclusion of BCG vaccination at birth in their national vaccination programs. Interestingly, those countries where BCG vaccination is given at birth have shown a lower contagion rate and fewer COVID-19-related deaths, suggesting that this vaccine may induce trained immunity that could confer some protection for SARS-CoV-2.


title: The possible impairment of respiratory-related neural loops may be associated with the silent pneumonia induced by SARS-CoV-2

text: As compared to many other viral pulmonary infections, there existed several peculiar manifestations in the COVID-19 patients, including the "silence" of pneumonia in both mild and severe cases and a long intensive care unit stay for those requiring invasive mechanical ventilation. Similar silent pneumonia has been documented in the infectioninduced by H5N1 influenza virus HK483 and was found to result from the direct attack of the virus on the bronchopulmonary C-fibers at the early stage and the final infection in the brainstem at the late stage. The long stay of critical patients in the intensive care unit is possibly due to the depression of central respiratory drive, which resulted in the failure to wean from the mechanic ventilation. Carotid and aortic bodies and bronchopulmonary C-fibers are two key peripheral components responsible for the chemosensitive responses in the respiratory system, while triggering respiratory reflexes depends predominantly on the putative chemosensitive neurons located in the pontomedullary nuclei. In view of the findings for the H5N1 influenza virus, the silence of pneumonia induced by SARS-CoV-2 may be due to the possible impairment of peripheral chemosensitive reflexes as well as the damage to the respiratory-related central neurons.


An Orthopaedic Department's Response to the COVID-19 Health-Care Crisis: Indirect and Direct Actions with Thoughts for the Future


The Rising Number of COVID-19 Cases Reflecting Growing Search Trend and Concern of People: A Google Trend Analysis of Eight Major Countries


Tocilizumab for severe COVID-19: A promising intervention affecting inflammation and coagulation


Information Technology-Based Tracing Strategy in Response to COVID-19 in South Korea-Privacy Controversies


Teledermatology for COVID-19 cutaneous lesions: substitute or supplement?


Impacts of the coronavirus pandemic on biodiversity conservation


title: Effective containment explains subexponential growth in recent confirmed COVID-19 cases in China

text: The recent outbreak of coronavirus disease 2019 (COVID-19) in mainland China was characterized by a distinctive subexponential increase of confirmed cases during the early phase of the epidemic, contrasting with an initial exponential growth expected for an unconstrained outbreak. We show that this effect can be explained as a direct consequence of containment policies that effectively deplete the susceptible population. To this end, we introduce a parsimonious model that captures both quarantine of symptomatic infected individuals, as well as population-wide isolation practices in response to containment policies or behavioral changes, and show that the model captures the observed growth behavior accurately. The insights provided here may aid the careful implementation of containment strategies for ongoing secondary outbreaks of COVID-19 or similar future outbreaks of other emergent infectious diseases.


Bilateral trochlear nerve palsy due to cerebral vasculitis related to COVID-19 infection


Demand for BCG Vaccine Due to Unproven Claims of its Role in Preventing COVID-19 Is Causing Shortages of Vaccines for Infants in Japan


title: Assessment of YouTube as an Educational Tool in Teaching Key Indicator Cases in Otolaryngology During the COVID-19 Pandemic and Beyond: Neck Dissection

text: OBJECTIVES: YouTube has become the preferred resource for trainees in otolaryngology to prepare for surgery. This study aimed to compare the evaluation by 2 attending physicians and 2 resident physicians of the quality of videos on YouTube on neck dissection, a key indicator case in head and neck surgery. The authors aimed to assess the quality and quantity of YouTube videos available for development of a virtual surgical educational curriculum for trainees in otolaryngology. METHODS: Using the YouTube search feature, the top 10 videos by relevance and view count were compiled using the following search terms: radical neck dissection, selective neck dissection, modified radical neck dissection, lateral neck dissection, levels I-III neck dissection, levels II-IV, left neck dissection, right neck dissection, cervical nodal dissection, and supraomohyoid neck dissection. A total of 37 videos on neck dissection were identified and analyzed using the LAP-VEGaS criteria as well as author-specific modified LAP-VEGaS criteria. RESULTS: The mean comprehensive LAP-VEGaS score was 8.74 (SD 3.10). The majority of videos (24/37) were designated as medium quality; 10 of 37 videos were low quality and 3 of 37 videos were high quality. In the total group analysis, there was excellent inter-rater reliability between attending physicians (Cohen's kappa coefficient of 0.84) and good inter-rater reliability between resident physicians (Cohen's kappa coefficient of 0.58). There was no correlation between total view count, video age, or number of likes/dislikes and the overall LAP-VEGaS score. The presence of audio or written commentary had a moderate positive correlation with LAP-VEGaS score (adjusted R2 of 0.36). There was no statistically significant difference in video quality between videos posted by US and non-US based physicians (95% confidence interval -0.10 to 4.10; pâ¯=â¯0.06). However, videos made by an otolaryngology-trained physician had a LAP-VEGaS score that was 3.93 points higher (95% confidence interval 2.34-5.52; p < 0.001) than that of videos made by a nonotolaryngology-trained physician. CONCLUSIONS: Online videos of neck dissection represent an increasingly ubiquitous and appropriate resource for trainees in learning otolaryngology key indicator cases. While free-to-access video repositories, such as YouTube, have become increasingly popular among trainees as a primary resource for learning and preparing for surgical cases, they lack consistent quality and as such, global efforts should be taken to improve the breadth and depth of educational video content in otolaryngology. LEVEL OF EVIDENCE: N/A.


Exercício Físico em Pacientes Cardiopatas e na População em Tempos de Coronavírus./ Exercício Físico em Pacientes Cardiopatas e na População em Tempos de Coronavírus./ Physical Exercise in Patients with Heart Disease and in the General Population in Times of Coronavirus


Coronavirus Disease (Covid-19): What Are We Learning in a Country With High Mortality Rate?


title: Widespread severe acute respiratory coronavirus virus 2 (SARS-CoV-2) laboratory surveillance program to minimize asymptomatic transmission in high-risk inpatient and congregate living settings

text: We describe a widespread laboratory surveillance program for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) at an integrated medical campus that includes a tertiary-care center, a skilled nursing facility, a rehabilitation treatment center, and temporary shelter units. We identified 22 asymptomatic cases of SARS-CoV-2 and implemented infection control measures to prevent SARS-CoV-2 transmission in congregate settings.


title: Baby pangolins on my plate: possible lessons to learn from the COVID-19 pandemic

text: The Journal of Ethnobiology and Ethnomedicine (JEET), throughout its 15 years of existence, has tried to provide a respected outlet for scientific knowledge concerning the inextricable links between human societies and nature, food, and health. Ethnobiology and ethnomedicine-centred research has moved at the (partially artificial and fictitious) interface between nature and culture and has investigated human consumption of wild foods and wild animals, as well as the use of wild animals or their parts for medicinal and other purposes, along with the associated knowledge, skills, practices, and beliefs. Little attention has been paid, however, to the complex interplay of social and cultural reasons behind the increasing pressure on wildlife. The available literature suggest that there are two main drivers that enhance the necessary conditions for infectious diseases to cross the species barrier from wild animals to humans: (1) the encroachment of human activities (e.g., logging, mining, agricultural expansion) into wild areas and forests and consequent ecological disruptions; and, connected to the former, (2) the commodification of wild animals (and natural resources in general) and an expanding demand and market for wild meat and live wild animals, particularly in tropical and sub-tropical areas. In particular, a crucial role may have been played by the bushmeat-euphoria and attached elitist gastronomies and conspicuous consumption phenomena. The COVID-19 pandemic will likely require ethnobiologists to reschedule research agendas and to envision new epistemological trajectories aimed at more effectively mitigating the mismanagement of natural resources that ultimately threats our and other beings' existence.


title: [Scenario-based study of medical resource requirement rapid assessment under the COVID-19 pandemic]

text: Objective: COVID-19 outbreak is still under global pandemic. China is facing the risks of importation and local rebound of COVID-19. Under the circumstances, preparations for medical resources are in urgently needed. Methods: Based on current understanding of the disease, we set up five scenarios and use the infectious disease transmission dynamic and pandemic theoretical static models to evaluate the demand for medical resources. Results: Different epidemic strength and strategies of disease control and prevention resulted in different levels of medical resource request, and active control strategy and effective measures could significantly decrease the requirement. During the epidemic rising phase, the cost of prevention and control measures and the requirement of professional response capacities would increase with potential high risk of medical resource demand sharply increasing. Conclusion: Regions with different economic level, population scale, and different prevention and control capabilities should all initiate scientific assessment of medical resource requirement under emergency response and prepare for possible future rebound and epidemic.


Why self-managed abortion is so much more than a provisional solution for times of pandemic


title: Social Work Values in Action during COVID-19

text: COVID-19 has ravaged through the lives of individuals, families, communities, and societies and, in the process, exacerbated existing vulnerabilities, oppression, and poverty among our most at-risk community members. Social workers, guided by values and ethics, are counteracting these ailments in society, concentrating on protecting the most vulnerable, older adults. In this letter we describe the impact of COVID-19 on older adults, note social work values from the National Association of Social Workers, and expand on the current role of the practicing social worker values in action during COVID.


title: Do superspreaders generate new superspreaders? A hypothesis to explain the propagation pattern of COVID-19

text: The current global propagation of COVID-19 is heterogeneous, with slow transmission continuing in many countries and exponential propagation in others, where the time that it took for the explosive spread to begin varied greatly. It is proposed that this could be explained by cascading superspreading events, in which new infections caused by a superspreader are more likely to be highly infectious. The mechanism suggested for this is related to viral loads. Exposure to high viral loads may result in high-intensity infection, which exposes new cases to high viral loads. This notion is supported by experimental veterinary research.


title: Mask use during COVID-19: A risk adjusted strategy

text: In the context of Coronavirus Disease (2019) (COVID-19) cases globally, there is a lack of consensus across cultures on whether wearing face masks is an effective physical intervention against disease transmission. This study 1) illustrates transmission routes of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2); 2) addresses controversies surrounding the mask from perspectives of attitude, effectiveness, and necessity of wearing the mask with evidence that the use of mask would effectively interrupt the transmission of infectious diseases in both hospital settings and community settings; and 3) provides suggestion that the public should wear the mask during COVID-19 pandemic according to local context. To achieve this goal, government should establish a risk adjusted strategy of mask use to scientifically publicize the use of masks, guarantee sufficient supply of masks, and cooperate for reducing health resources inequities.


docid: nhermrtq

title: Consent in the time of COVID-19

text: The COVID-19 pandemic crisis has necessitated widespread adaptation of revised treatment regimens for both urgent and routine medical problems in patients with and without COVID-19. Some of these alternative treatments maybe second-best. Treatments that are known to be superior might not be appropriate to deliver during a pandemic when consideration must be given to distributive justice and protection of patients and their medical teams as well the importance given to individual benefit and autonomy. What is required of the doctor discussing these alternative, potentially inferior treatments and seeking consent to proceed? Should doctors share information about unavailable but standard treatment alternatives when seeking consent? There are arguments in defence of non-disclosure; information about unavailable treatments may not aid a patient to weigh up options that are available to them. There might be justified concern about distress for patients who are informed that they are receiving second-best therapies. However, we argue that doctors should tailor information according to the needs of the individual patient. For most patients that will include a nuanced discussion about treatments that would be considered in other times but currently unavailable. That will sometimes be a difficult conversation, and require clinicians to be frank about limited resources and necessary rationing. However, transparency and honesty will usually be the best policy.


SARS-CoV-2 causes COVID-19-like disease in cynomolgus macaques


title: Increased Pathogenicity and Virulence of Virus in Middle East Respiratory Syndrome Coronavirus Clade B in Vitro and in Vivo

text: Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe acute respiratory disease in humans. MERS-CoV strains from early epidemic clade A and contemporary epidemic clade B have not been phenotypically characterized to compare their ability to infect cells and mice. We isolated the clade B MERS-CoV ChinaGD01 strain from a patient infected during the South Korean MERS outbreak in 2015 and compared the phylogenetics and pathogenicity of MERS-CoV EMC/2012 (clade A) and ChinaGD01 (clade B) in vitro and in vivo Genome alignment analysis showed that most of clade-specific mutations occurred in the orf1ab gene, included mutations that were predicted to be potential glycosylation sites. Minor differences in viral growth but no significant differences in plaque-size and sensitivity to IFN-ß were detected between these two viruses in vitro ChinaGD01 virus infection induced more weight loss and inflammatory cytokine production in human DPP4 transduced mice. Viral titers were higher in the lungs of ChinaGD01 infected mice as compared to EMC/2012 infection. Decreased virus-specific CD4+ and CD8+ T cells numbers were detected in the lungs of ChinaGD01 infected mice. Together, MERS-CoV evolution induced changes to reshape its pathogenicity and virulence in vitro and in vivo and to evade adaptive immune response to hinder viral clearance.IMPORTANCE MERS-CoV is an important emerging pathogen and causes severe respiratory infection in humans. MERS-CoV strains from early epidemic clade A and contemporary epidemic clade B have not been phenotypically characterized to compare their ability to infect cells and mice. Here, we showed that a clade B virus ChinaGD01 strain caused more severe disease in mice with delayed viral clearance, increased inflammatory cytokines and decreased anti-viral T cells responses compared to the early clade A virus EMC/2012. Given the differences in pathogenicity of different clades of MERS-CoV, periodic assessment of currently circulating MERS-CoV is needed to monitor potential severity of zoonotic disease.


Behandling av multippel sklerose under covid-19-pandemien./ Behandling av multippel sklerose under covid-19-pandemien./ Treatment of multiple sclerosis under the COVID-19 pandemic


title: Extracting and categorising the reactions to COVID-19 by the South African public -- A social media study

text: Social Media can be used to extract discussion topics during a disaster. With the COVID-19 pandemic impact on South Africa, we need to understand how the law and regulation promulgated by the government in response to the pandemic contrasts with discussion topics social media users have been engaging in. In this work, we expand on traditional media analysis by using Social Media discussions driven by or directed to South African government officials. We find topics that are similar as well as different in some cases. The findings can inform further study into social media during disaster settings in South Africa and beyond.


title: COVID-19 Clinical Trials: A Primer for the Cardiovascular and Cardio-Oncology Communities

text: The COVID-19 pandemic has resulted in a proliferation of clinical trials that are designed to slow the spread of SARS-CoV-2, the virus that causes COVID-19. The overwhelming majority of cardiovascular and cancer patients are at increased risk for SARS-CoV-2 infection; accordingly, the cardiovascular and cardio-oncology communities are playing a major role in caring for COVID-19 patients. Many of the therapeutic agents that are being used to treat patients with COVID-19 are repurposed treatments for influenza, drugs that were not effective in Ebola patients, or treatments for malaria that were developed decades ago, and are unlikely to be familiar to the cardiovascular and cardio-oncology communities. Here we have provided a foundation for cardiovascular and cardio-oncology physicians who are on the frontline providing care to COVID-19 patients, so that they can better understand the emerging cardiovascular epidemiology of COVID-19, as well as the biological rationale for the clinical trials that are ongoing for the treatment of COVID-19 patients.


title: Efficacy and safety of aerosolized intra-tracheal dornase alfa administration in patients with SARS-CoV-2-induced acute respiratory distress syndrome (ARDS): a structured summary of a study protocol for a randomised controlled trial

text: OBJECTIVES: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) may trigger severe pneumonia in coronavirus disease of 2019 (COVID-19) patients through release of damage-associated molecular patterns (DAMPs) and recruitment of neutrophils in the lungs. Activated neutrophils induce inflammation and severe alveolar injury by releasing neutrophil extracellular traps (NETs). The backbones of many DAMPs and NETs are made of extracellular, cell-free DNA decorated with highly toxic compounds such as elastase, myeloperoxidase and citrullinated histones. Dornase alfa is a FDA-approved recombinant human DNAse 1 for the treatment of cystic fibrosis, which cleaves extracellular DNA and may break up cell-free DNA, loosening sticky mucus in the distal airways and reducing NETs-induced toxicity on alveolar pneumocytes. The COVIDornase trial intends to define the impact of aerosolized intra-tracheal dornase alfa administration on the severity and progression of acute respiratory distress syndrome (ARDS) in COVID-19 patients. This drug might make lung mucus thinner and looser, promoting improved clearance of secretions and reduce extracellular double-stranded DNA-induced hyperinflammation in alveoli, preventing further damage to the lungs. TRIAL DESIGN: COVIDornase is a prospective, randomized, controlled, 2-arm (1:1 ratio), multicentric, open-label clinical trial. PARTICIPANTS: The study will recruit mechanically ventilated patients hospitalized in the intensive care unit (ICU) in the recruiting centres (at the time of writing: The Rothschild foundation hospital in Paris, the Strasbourg university hospitals, and Metz-Thionville hospital) who have been diagnosed with COVID-19 and meet ARDS criteria. INCLUSION CRITERIA: - Adult patient (age ≥ 18 years old); - Hospitalized in ICU; - With severe COVID-19 pneumonia and ARDS according to Berlin criteria (PaO2/FiO2 < 300 and PEEP > 5 cmH2O); - Intubated for less than 8 days; - With an anticipated duration of mechanical ventilation > 48 hours; - Carrier of an arterial catheter; - For whom 4 PaO2/FiO2 values over the preceding 24 hours are available; NON-INCLUSION CRITERIA: - Known hypersensitivity to dornase alfa or any of its excipients; - Pregnant or breastfeeding status; - Patient under legal protection. INTERVENTION AND COMPARATOR: Intervention 1, Study group Dornase alfa (Pulmozyme®, Roche, Switzerland) will be administered by aerosol, at a dose of 2500 IU twice daily, 12 hours apart, for 7 consecutive days, using a vibrating mesh nebulizer (Aerogen Solo®, Aerogen, Ireland). The remainder of the management will be performed in accordance with good clinical practice, including mechanical ventilation (protective ventilation, PEEP > 5 cmH2O, tracheal balloon pressure check every 4 hours or automatic device, 30° head of the bed elevation, tidal volume 6-8mL/kg, plateau pressure < 30 cmH2O), neuromuscular blockers if necessary, prone position if PaO2/FiO2 < 150, early enteral nutrition, glycemic control and a sedation protocol based on the RASS score. Intervention 2, Comparator Patients will receive usual care in accordance with good practice (as detailed above), without aerosols. MAIN OUTCOMES: The primary outcome is the occurrence of at least one grade improvement between D0 (inclusion) and D7 in the ARDS scale severity (Berlin criteria). For instance from "severe" to "moderate" or from "moderate" to "mild". RANDOMISATION: All consecutive patients meeting the inclusion criteria will be randomised 1:1 using an eCRF-based, computer-generated randomisation table, either to the dornase alfa arm or to the control arm. An interim analysis will be performed after inclusion of 20 patients. Inclusions may be stopped at the interim analysis per data safety and monitoring board (DSMB) advice, if statistical analyses conclude on the futility or efficacy of the intervention or by other DSMB decision. BLINDING (MASKING): The participants and caregivers will not be blinded to study group assignment. Those assessing the outcomes will be blinded to study group assignment. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): Fifty patients will be randomized to each group, 100 patients in total. TRIAL STATUS: Protocol version number 2, April 29th, 2020. Recruitment is ongoing. The trial started recruitment on the 21st April 2020. We estimate recruitment will finish August 21st 2020. TRIAL REGISTRATION: The trial was registered in ClinicalTrials.gov on 21 April 2020, updated on 8 May 2020. Trial registration number is NCT04355364. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated. This Letter serves as a summary of the key elements of the full protocol.


Indigenous communities in Brazil fear pandemic's impact


D-Dimer serum levels as a biomarker associated for the lethality in patients with coronavirus disease 2019: a meta-analysis


Lung Ultrasound findings in COVID-19 Pneumonia


Tabagisme et maladie à coronavirus 2019 (COVID-19)./ [Smoking and coronavirus disease 2019 (COVID-19)]


title: Retrospective estimation of respiratory virus covariances using Bayesian multivariate autoregressive models

text: Respiratory infections in humans are caused by a diverse community of co-circulating viral species including viruses that cause influenza and the common cold. Public health interventions such as vaccination programs typically focus on individual viral species. However, observational data suggest that the spread of one species may impact the dynamics of another. This finding would have important implications for the predicted impact of seasonal vaccines but currently lacks statistical support. The aim of this paper is to develop a statistical framework to identify non-independent viral dynamics. As Bayesian multivariate disease mapping models naturally encompass a between-disease covariance matrix, we extended this framework to model multivariate time series data accounting for within- and between-year dependencies. By inferring non-zero off-diagonal entries of the between-disease covariance matrix, we present a novel technique that successfully identifies significant viral interactions. We illustrate this framework using incidence data from five co-circulating respiratory viruses (adenovirus [AdV], coronavirus [Cov], human metapneumovirus [MPV], influenza B virus [IBV] and respiratory syncytial virus [RSV]) detected by routine diagnostics at the West of Scotland Specialist Virology Center (WoSSVC) between 2005 and 2013. We found a significant positive covariance between RSV \&MPV and a negative covariance between IBV \&AdV paving the way for future examination of biological or behavioural factors that may generate interactions between certain virus pairs.


ECMO for ARDS due to COVID-19


title: Nonoperating room anesthesia for patients with serious comorbidities

text: PURPOSE OF REVIEW: To provide aids to deal with increasing amount of several comorbidities in nonoperating room anesthesia (NORA). RECENT FINDINGS: New indexes for assessment of comorbidities are described and guidelines for the care of patients with obesity, obstructive sleep apnea, chronic obstructive pulmonary disease (COPD), diabetes and COVID19 in NORA summarized. SUMMARY: In addition to ASA classification, such instruments as Charlson Comorbidity Index, Frailty Index, Surgical Complexity Score and Revised Cardiac Risk could supplement the prospective assessment of the risk of comorbidities. Using institutional protocols patients with significant obesity, obstructive sleep apnea, COPD, diabetes and COVID19 can be safely cared in NORA. However, the individual functioning and the severity are more important than only the number of diseases.


Remdesivir - An Important First Step


Assessing Viral Shedding and Infectivity of Tears in Coronavirus Disease 2019 (COVID-19) Patients


Letter to the Editor 'Neurosurgical Service Coverage During the COVID-19 Pandemic: The 'Battle Plan' at the University of South of Florida Affiliate Hospitals'


Our education, our concerns: The impact on medical student education of COVID-19


Understanding COVID-19: what does viral RNA load really mean?


docid: wsjtdhim

title: Conservation of personal protective equipment for head and neck cancer surgery during COVID-19 pandemic

text: BACKGROUND: COVID-19 pandemic has led to a global shortage of personal protective equipment (PPE). This study aims to stratify face shield needs when performing head and neck cancer surgery. METHODS: Fifteen patients underwent surgery between March 1, 2020 and April 9, 2020. Operative diagnosis and procedure; droplet count and distribution on face shields were documented. RESULTS: Forty-five surgical procedures were performed for neck nodal metastatic carcinoma of unknown origin (n = 3); carcinoma of tonsil (n = 2), tongue (n = 2), nasopharynx (n = 3), maxilla (n = 1), and laryngopharynx (n = 4). Droplet contamination was 57.8%, 59.5%, 8.0%, and 0% for operating, first and second assistant surgeons, and scrub nurse respectively. Droplet count was highest and most widespread during osteotomies. No droplet splash was noted for transoral robotic surgery. CONCLUSION: Face shield is not a mandatory adjunctive PPE for all head and neck surgical procedures and health care providers. Judicious use helps to conserve resources during such difficult times.


title: LGBTQ+ Inclusive Palliative Care in the Context of COVID-19: Pragmatic Recommendations for Clinicians

text: As coronavirus disease 2019 (COVID-19) continues to impact the seriously ill and their families on a global scale, considerations given to marginalized groups amid the pandemic are essential to ensure the provision of high-quality and dignified care. Lesbian, gay, bisexual, transgender, gender-nonconforming, and queer/questioning-identified (LGBTQ+) persons are particularly vulnerable to health inequities across settings, including palliative care and at the end of life. There is a crucial gap in the literature pertaining to palliative care for LGBTQ+ populations during COVID-19. We aim to fill this gap by providing essential health inequity and social support background pertaining to LGBTQ+ persons and practical recommendations for immediate implementation that support inclusive and respectful care for these populations. Using these recommendations is a pragmatic pathway to promote trust, transparency, patient and family engagement, and value concordant care amid the health system strain caused by COVID-19.


title: Challenges in Combating COVID-19 Infodemic -- Data, Tools, and Ethics

text: While the COVID-19 pandemic continues its global devastation, numerous accompanying challenges emerge. One important challenge we face is to efficiently and effectively use recently gathered data and find computational tools to combat the COVID-19 infodemic, a typical information overloading problem. Novel coronavirus presents many questions without ready answers; its uncertainty and our eagerness in search of solutions offer a fertile environment for infodemic. It is thus necessary to combat the infodemic and make a concerted effort to confront COVID-19 and mitigate its negative impact in all walks of life when saving lives and maintaining normal orders during trying times. In this position paper of combating the COVID-19 infodemic, we illustrate its need by providing real-world examples of rampant conspiracy theories, misinformation, and various types of scams that take advantage of human kindness, fear, and ignorance. We present three key challenges in this fight against the COVID-19 infodemic where researchers and practitioners instinctively want to contribute and help. We demonstrate that these three challenges can and will be effectively addressed by collective wisdom, crowdsourcing, and collaborative research.


Ultrasound-guided minimally invasive autopsies: A protocol for the study of pulmonary and systemic involvement of COVID-19