title: Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: A systematic review and critical analysis

text: BACKGROUND: Early reports of COVID-19 in pregnancy described management by caesarean, strict isolation of the neonate and formula feeding, is this practise justified? OBJECTIVE: To estimate the risk of the neonate becoming infected with SARS-COV-2 by mode of delivery, type of infant feeding and mother-infant interaction SEARCH STRATEGY: Two biomedical databases were searched between September 2019 - June 2020. SELECTION CRITERIA: Case reports or case series of pregnant women with confirmed COVID-19, where neonatal outcomes were reported. DATA COLLECTION AND ANALYSIS: Data was extracted on mode of delivery, infant infection status, infant feeding and mother-infant interaction. For reported infant infection a critical analysis was performed to evaluate the likelihood of vertical transmission. MAIN RESULTS: We included 49 studies which included 666 neonates and 655 women where information was provided on the mode of delivery and the infant's infection status. 28/666 (4%) neonates had confirmed COVID-19 infection postnatally. Of the 291 women who delivered vaginally, 8/292 (2.7%) neonates were positive. Of the 364 women who had a Caesarean birth, 20/374 (5.3%) neonates were positive. Of the 28 neonates with confirmed COVID-19 infection, 7 were breast fed, 3 formula fed, 1 was given expressed breast milk and in 17 neonates the method of infant feeding was not reported. CONCLUSIONS: Neonatal COVID-19 infection is uncommon, uncommonly symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfed or allowed contact with the mother.


Performing Structural Heart Disease Interventions During the COVID-19 Pandemic: But What Are the Downsides?


title: Incidence of COVID-19 in patients with rheumatic diseases treated with targeted immunosuppressive drugs: what can we learn from observational data?

text: OBJECTIVES: To describe the incidence and severity of coronavirus disease 2019 (COVID-19) in rheumatic patients treated with targeted synthetic or biological anti-rheumatic drugs (ts/bDMARDs) compared with the general population living in the same Italian region. METHODS: Patients followed at two referral rheumatology centres in Lombardy from 25th February to 10th April 2020 were invited to participate in a survey to detect patients with confirmed COVID-19, close contacts with known COVID-19 cases, symptoms of infection, working, behavioural and disease management changes applied to prevent the contagion. The incidence of COVID-19 in the Lombardy population was obtained from the National Institute of Statistics. Confirmed COVID-19 was defined by nasopharyngeal swab. RESULTS: The survey was circulated amongst 955 patients (531 rheumatoid arthritis, 203 psoriatic arthritis, 181 spondyloarthritis, and 40 of connective tissue diseases/vasculitides/autoinflammatory diseases; mean age 53.7 years; female: 67.4%). The rate of responders was 98.05%. The incidence of confirmed COVID-19 is consistent with the general population (0.62% vs 0.66%; p=0.92). None of the patients had severe complications or required intensive care treatment, and all of them temporarily discontinued ongoing ts/bDMARDs therapy. Almost all patients adopted precautions to prevent the contagion (90.6%) and maintained the ongoing treatment with ts/bDMARDs (93.2%). The disease activity remained stable in 89.5% of patients. CONCLUSIONS: Our results highlight the attitude from rheumatic patients to prevent the contagion while maintaining their chronic treatments. The incidence and severity of COVID-19 in patients treated with ts/bDMARDs was not significantly different from that of the general population in the same region.


title: Rapid and visual detection of 2019 novel coronavirus (SARS-CoV-2) by a reverse transcription loop-mediated isothermal amplification assay

text: OBJECTIVE: To evaluate a reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and compare it with RT-PCR. METHODS: We designed primers specific to the orf1ab and S genes of SARS-CoV-2. Total viral RNA was extracted using the QIAamp Viral RNA Mini Kit. We optimized the RT-LAMP assay, and evaluated it for its sensitivity and specificity of detection using real-time turbidity monitoring and visual observation. RESULTS: The primer sets orf1ab-4 and S-123 amplified the genes in the shortest times, the mean (±SD) times were 18 ± 1.32 min and 20 ± 1.80 min, respectively, and 63°C was the optimum reaction temperature. The sensitivities were 2 × 101 copies and 2 × 102 copies per reaction with primer sets orf1ab-4 and S-123, respectively. This assay showed no cross-reactivity with 60 other respiratory pathogens. To describe the availability of this method in clinical diagnosis, we collected 130 specimens from patients with clinically suspected SARS-CoV-2 infection. Among them, 58 were confirmed to be positive and 72 were negative by RT-LAMP. The sensitivity was 100% (95% CI 92.3%-100%), specificity 100% (95% CI 93.7%-100%). This assay detected SARS-CoV-2 in a mean (±SD) time of 26.28 ± 4.48 min and the results can be identified with visual observation. CONCLUSION: These results demonstrate that we developed a rapid, simple, specific and sensitive RT-LAMP assay for SARS-CoV-2 detection among clinical samples. It will be a powerful tool for SARS-CoV-2 identification, and for monitoring suspected patients, close contacts and high-risk groups.


title: De novo design of protein peptides to block association of the SARS-CoV-2 spike protein with human ACE2

text: The outbreak of COVID-19 has now become a global pandemic that has severely impacted lives and economic stability. There is, however, no effective antiviral drug that can be used to treat COVID-19 to date. Built on the fact that SARS-CoV-2 initiates its entry into human cells by the receptor binding domain (RBD) of its spike protein binding to the angiotensin-converting enzyme 2 (hACE2), we extended a recently developed approach, EvoDesign, to design multiple peptide sequences that can competitively bind to the SARS-CoV-2 RBD to inhibit the virus from entering human cells. The protocol starts with the construction of a hybrid peptidic scaffold by linking two fragments grafted from the interface of the hACE2 protein (a.a. 22-44 and 351-357) with a linker glycine, which is followed by the redesign and refinement simulations of the peptide sequence to optimize its binding affinity to the interface of the SARS-CoV-2 RBD. The binding experiment analyses showed that the designed peptides exhibited a significantly stronger binding potency to hACE2 than the wild-type hACE2 receptor (with -53.35 vs. -46.46 EvoEF2 energy unit scores for the top designed and wild-type peptides, respectively). This study demonstrates a new avenue to utilize computationally designed peptide motifs to treat the COVID-19 disease by blocking the critical spike-RBD and hACE2 interactions.


COVID-19: New York City pandemic notes from the first 30 days


title: Light as a potential treatment for pandemic coronavirus infections: A perspective

text: The recent outbreak of COVID-19, which continues to ravage communities with high death tolls and untold psychosocial and catastrophic economic consequences, is a vivid reminder of nature's capacity to defy contemporary healthcare. The pandemic calls for rapid mobilization of every potential clinical tool, including phototherapy-one of the most effective treatments used to reduce the impact of the 1918 "Spanish influenza" pandemic. This paper cites several studies showing that phototherapy has immense potential to reduce the impact of coronavirus diseases, and offers suggested ways that the healthcare industry can integrate modern light technologies in the fight against COVID-19 and other infections. The evidence shows that violet/blue (400-470 nm) light is antimicrobial against numerous bacteria, and that it accounts for Niels Ryberg Finsen's Nobel-winning treatment of tuberculosis. Further evidence shows that blue light inactivates several viruses, including the common flu coronavirus, and that in experimental animals, red and near infrared light reduce respiratory disorders, similar to those complications associated with coronavirus infection. Moreover, in patients, red light has been shown to alleviate chronic obstructive lung disease and bronchial asthma. These findings call for urgent efforts to further explore the clinical value of light, and not wait for another pandemic to serve as a reminder. The ubiquity of inexpensive light emitting lasers and light emitting diodes (LEDs), makes it relatively easy to develop safe low-cost light-based devices with the potential to reduce infections, sanitize equipment, hospital facilities, emergency care vehicles, homes, and the general environment as pilot studies have shown.


Mission command: applying principles of military leadership to the SARS-CoV-2 (COVID-19) crisis: more than just 'mission command'


title: Cellular Nanosponges Inhibit SARS-CoV-2 Infectivity

text: We report cellular nanosponges as an effective medical countermeasure to the SARS-CoV-2 virus. Two types of cellular nanosponges are made of the plasma membranes derived from human lung epithelial type II cells or human macrophages. These nanosponges display the same protein receptors, both identified and unidentified, required by SARS-CoV-2 for cellular entry. It is shown that, following incubation with the nanosponges, SARS-CoV-2 is neutralized and unable to infect cells. Crucially, the nanosponge platform is agnostic to viral mutations and potentially viral species, as well. As long as the target of the virus remains the identified host cell, the nanosponges will be able to neutralize the virus.


Profile of specific antibodies to SARS-CoV-2: The first report


title: Framing COVID-19: How we conceptualize and discuss the pandemic on Twitter

text: Doctors and nurses in these weeks are busy in the trenches, fighting against a new invisible enemy: Covid-19. Cities are locked down and civilians are besieged in their own homes, to prevent the spreading of the virus. War-related terminology is commonly used to frame the discourse around epidemics and diseases. Arguably the discourse around the current epidemic will make use of war-related metaphors too,not only in public discourse and the media, but also in the tweets written by non-experts of mass communication. We hereby present an analysis of the discourse around #Covid-19, based on a corpus of 200k tweets posted on Twitter during March and April 2020. Using topic modelling we first analyze the topics around which the discourse can be classified. Then, we show that the WAR framing is used to talk about specific topics, such as the virus treatment, but not others, such as the effects of social distancing on the population. We then measure and compare the popularity of the WAR frame to three alternative figurative frames (MONSTER, STORM and TSUNAMI) and a literal frame used as control (FAMILY). The results show that while the FAMILY literal frame covers a wider portion of the corpus, among the figurative framings WAR is the most frequently used, and thus arguably the most conventional one. However, we conclude, this frame is not apt to elaborate the discourse around many aspects involved in the current situation. Therefore, we conclude, in line with previous suggestions, a plethora of framing options, or a metaphor menu, may facilitate the communication of various aspects involved in the Covid-19-related discourse on the social media, and thus support civilians in the expression of their feelings, opinions and ideas during the current pandemic.


title: Estimating the number of infections and the impact of non-pharmaceutical interventions on COVID-19 in European countries: technical description update

text: Following the emergence of a novel coronavirus (SARS-CoV-2) and its spread outside of China, Europe has experienced large epidemics. In response, many European countries have implemented unprecedented non-pharmaceutical interventions including case isolation, the closure of schools and universities, banning of mass gatherings and/or public events, and most recently, wide-scale social distancing including local and national lockdowns. In this technical update, we extend a semi-mechanistic Bayesian hierarchical model that infers the impact of these interventions and estimates the number of infections over time. Our methods assume that changes in the reproductive number - a measure of transmission - are an immediate response to these interventions being implemented rather than broader gradual changes in behaviour. Our model estimates these changes by calculating backwards from temporal data on observed to estimate the number of infections and rate of transmission that occurred several weeks prior, allowing for a probabilistic time lag between infection and death. In this update we extend our original model [Flaxman, Mishra, Gandy et al 2020, Report #13, Imperial College London] to include (a) population saturation effects, (b) prior uncertainty on the infection fatality ratio, (c) a more balanced prior on intervention effects and (d) partial pooling of the lockdown intervention covariate. We also (e) included another 3 countries (Greece, the Netherlands and Portugal). The model code is available at https://github.com/ImperialCollegeLondon/covid19model/ We are now reporting the results of our updated model online at https://mrc-ide.github.io/covid19estimates/ We estimated parameters jointly for all M=14 countries in a single hierarchical model. Inference is performed in the probabilistic programming language Stan using an adaptive Hamiltonian Monte Carlo (HMC) sampler.


Coronavirus vaccine developers wary of errant antibodies


title: Clinical Characteristics and Outcomes of COVID-19 Patients With a History of Stroke in Wuhan, China

text: BACKGROUND AND PURPOSE: Information on stroke survivors infected with coronavirus disease 2019 (COVID-19) is limited. The aim of this study was to describe specific clinical characteristics and outcomes of patients with COVID-19 with a history of stroke. METHODS: All the confirmed cases of COVID-19 at Tongji Hospital from January 27 to March 5, 2020, were included in our cohort study. Clinical data were analyzed and compared between patients with and without a history of stroke. RESULTS: Of the included 1875 patients with COVID-19, 50 patients had a history of stroke. The COVID-19 patients with medical history of stroke were older with more comorbidities, had higher neutrophil count, and lower lymphocyte and platelet counts than those without history of stroke. The levels of D-dimers, cardiac troponin I, NT pro-brain natriuretic peptide, and interleukin-6 were also markedly higher in patients with history of stroke. Stroke survivors who underwent COVID-19 developed more acute respiratory distress syndrome and received more noninvasive mechanical ventilation. Data from propensity-matched analysis indicated a higher proportion of patients with COVD-19 with a history of stroke were admitted to the intensive care unit requiring mechanical ventilation and were more likely to be held in the unit or die, compared with non-stroke history COVID-19 patients. CONCLUSIONS: Patients with COVID-19 with a history of stroke had more severe clinical symptoms and poorer outcomes compared with those without a history of stroke.


title: Open questions for harnessing autophagy-modulating drugs in the SARS-CoV-2 war: hope or hype?

text: At a time when the world faces an emotional breakdown, crushing our dreams, if not, taking our lives, we realize that together we must fight the war against the COVID-19 outbreak even if almost the majority of the scientific community finds itself confined at home. Every day, we, scientists, listen to the latest news with its promises and announcements. Across the world, a surge of clinical trials trying to cure or slow down the coronavirus pandemic has been launched to bring hope instead of fear and despair. One first proposed clinical trial has drawn worldwide hype to the benefit of chloroquine (CQ), in the treatment of patients infected by the recently emerged deadly coronavirus (SARS-CoV-2). We should consider this information in light of the long-standing anti-inflammatory and anti-viral properties of CQ-related drugs. Yet, none of the articles promoting the use of CQ in the current pandemic evoked a possible molecular or cellular mechanism of action that could account for any efficacy. Here, given the interaction of viruses with macroautophagy (hereafter referred to as autophagy), a CQ-sensitive anti-viral safeguard pathway, we would like to discuss the pros, but also the cons concerning the current therapeutic options targeting this process.


High prevalence of deep vein thrombosis in mechanically ventilated COVID-19 patients


docid: cgugirih

title: The Novel Coronavirus Disease (COVID-19) Threat for Patients with Cardiovascular Disease and Cancer


title: A new era for nuclear medicine

text: The coronavirus COVID-19 pandemic is the defining global health crisis of our time. Health care systems globally are amid an unprecedented challenge. Since its emergence in December 2019 in Wuhan, China, the virus has spread to 185 countries worldwide, with more than 2.63 million cases confirmed and more than 183 thousand related deaths (as of 23/04/2020). According to current evidence, the novel coronavirus is transmitted from human-to-human mainly via respiratory droplets of different sizes, contact with bodily fluids, or from contaminated surfaces. In the context of COVID-19, airborne transmission may be possible in specific circumstances and settings in which procedures that generate aerosols are performed. The common clinical symptoms of the highly pathogenic and large-scale epidemic virus include fever, cough, fatigue, ageusia and anosmia and in some patients, gastrointestinal infection symptoms. The elderly and patients with comorbidities are susceptible to infection and prone to severe complications, which may be associated with acute respiratory distress syndrome (ARDS) and cytokines storm. Currently, there are few specific antiviral strategies, but several potent candidates of antivirals and repurposed drugs are under urgent investigation. Under these circumstances, it is critical for health care settings, including nuclear medicine departments to take infection control measures, to prevent a potential spread not just among patients but also to staff members as well as to reconsider the performance of randomized clinical trials. There have already been papers on the radiology preparedness that should be applied to radiology and nuclear medicine departments to support the care of patients with COVID-19 and maintain radiologic diagnostic and interventional support for the entirety of the hospital and healthcare system, particularly for emergencies, without jeopardizing an outbreak in the units. Since most nuclear medicine diagnostic and therapeutic interventions are non-urgent, the general guidance from the International Atomic Energy Agency (IAEA) for infection prevention and control is to postpone scheduled procedure after cautious risk assessment, with certain exceptions. Individualized approach of each case is a sine qua non of ensuring low transmission of COVID-19 as well as effective and safe management of patients admitted to nuclear medicine departments. Another major issue raised is the possible impact COVID-19 on the transport of medical radioisotopes. By the 1st of April 2020, the Euratom Supply Agency (ESA) co-chaired the European Observatory on Supply of Medical Radioisotope expressing their concerns related to the impact of COVID-19 on the supply chain and inconsequence on the availability of the most vital medical radioisotopes used in nuclear medicine. Due to the current lockdown situation, extended border controls, reductions and elimination of many commercial passenger flights, competition and cost of cargo and charter options, required appropriate additional support. The new era of nuclear medicine practice worldwide coincides with a new era for the Hellenic Society of Nuclear Medicine (HSNM) and the Hellenic Journal of Nuclear Medicine (HJNM). The founder and Editor in Chief for more than 28 consecutive years, Professor Emeritus Philip Grammaticos, resigned leaving behind a benchmark for the presidencies and editors to come. His commitment to the conservation of a high level of scientific excellence of the published papers is the legacy which we wish to maintain in the future publications. The interim Editor in Chief of the current issue, would like to express her gratitude to Professor Emeritus Philip Grammaticos for his contribution to the global scientific community as well as to the incoming Editor in Chief Konstantinos Anagnostopoulos, MD, PhD, FRCP, FESC for accepting this new role. We wholeheartedly welcome the new Editor in Chief and the new members of the Editorial Board, wishing them an active, attentive and successful mandate. Hellenic Journal of Nuclear Medicine will remain true to the set principles, values and past and prepared to cope with future challenges in the scientific and clinical setting.


title: Protein Structure and Sequence Reanalysis of 2019-nCoV Genome Refutes Snakes as Its Intermediate Host and the Unique Similarity between Its Spike Protein Insertions and HIV-1

text: As the infection of 2019-nCoV coronavirus is quickly developing into a global pneumonia epidemic, the careful analysis of its transmission and cellular mechanisms is sorely needed. In this Communication, we first analyzed two recent studies that concluded that snakes are the intermediate hosts of 2019-nCoV and that the 2019-nCoV spike protein insertions share a unique similarity to HIV-1. However, the reimplementation of the analyses, built on larger scale data sets using state-of-the-art bioinformatics methods and databases, presents clear evidence that rebuts these conclusions. Next, using metagenomic samples from Manis javanica, we assembled a draft genome of the 2019-nCoV-like coronavirus, which shows 73% coverage and 91% sequence identity to the 2019-nCoV genome. In particular, the alignments of the spike surface glycoprotein receptor binding domain revealed four times more variations in the bat coronavirus RaTG13 than in the Manis coronavirus compared with 2019-nCoV, suggesting the pangolin as a missing link in the transmission of 2019-nCoV from bats to human.


Clinical implications of COVID-19 in patients with chronic liver disease and liver tumor


title: Impact of COVID-19 pandemic on socioeconomic and mental health aspects in Nepal

text: BACKGROUND: Public health concern is increasing with recent rise in the number of COVID-19 cases in Nepal. To curb this pandemic, Nepal is facing some forms of lockdown, encouraging people to implement social distancing so as to reduce interactions between people which could eventually reduce the possibilities of new infection; however, it has affected the overall physical, mental, social and spiritual health of the people. METHODS: Published articles related to psychosocial effects due to COVID-19 and other outbreaks were searched and reviewed. CONCLUSION: While many countries are supporting their citizens with sophisticated health safety-nets and various relief funds, some developing countries have unique challenges with vulnerable populations and limited resources to respond to the pandemic. This review presents the consequences of pandemic and lockdown on socioeconomic, mental health and other aspects in Nepalese society.


Does prolonged propofol sedation of mechanically ventilated COVID-19 patients contribute to critical illness myopathy?


Recovery from COVID-19 following hepatitis C, human immunodeficiency virus infection, and liver transplantation


title: Blood biochemical characteristics of patients with coronavirus disease 2019 (COVID-19): a systemic review and meta-analysis

text: Objective Recently, there have been several studies on the clinical characteristics of patients with coronavirus disease 2019 (COVID-19); however, these studies have mainly been concentrated in Wuhan, China; the sample sizes of each article were different; and the reported clinical characteristics, especially blood biochemical indices, were quite different. This study aimed to summarize the blood biochemistry characteristics of COVID-19 patients by performing a systemic review and meta-analysis of published studies. Methods Comprehensive studies were screened from PubMed, Embase, and Cochrane Library through March 11, 2020. The inclusion criteria included studies investigating the biochemical indexes of patients with COVID-19. The statistical software R3.6.3 was used for meta-analysis. Results Ten studies including 1745 COVID-19 patients met the inclusion criteria for our meta-analysis. Meta-analysis showed that 16% and 20% of patients with COVID-19 had alanine transaminase (ALT) and aspartate aminotransferase (AST) levels higher than the normal range, respectively. Thirty-four percent of patients showed albumin (ALB) levels lower than the normal range, and 6% of patients showed abnormal total bilirubin (TBil) levels. The levels of creatinine (CRE) were increased in 8% of patients. The creatine kinase (CK) level of 13% of patients exceeded the normal range, and 52% of patients had elevated lactate dehydrogenase (LDH) levels. In addition, six studies met the inclusion criteria for the systemic review evaluating the relevance between LDH levels and the severity of COVID-19, and all six studies showed a positive association between these two factors. Conclusions Some patients with COVID-19 had different degrees of blood biochemical abnormalities, which might indicate multiple organ dysfunction. Some biochemical indexes, such as abnormal ALB and LDH, could reflect the severity of the disease to a certain extent. These blood biochemical indicators should be considered in the clinical management of the disease.


title: Scenarios for a post-COVID-19 world airline network

text: The airline industry was severely hit by the COVID-19 crisis with an average demand decrease of about $64\%$ (IATA, April 2020) which triggered already several bankruptcies of airline companies all over the world. While the robustness of the world airline network (WAN) was mostly studied as an homogeneous network, we introduce a new tool for analyzing the impact of a company failure: the `airline company network' where two airlines are connected if they share at least one route segment. Using this tool, we observe that the failure of companies well connected with others has the largest impact on the connectivity of the WAN. We then explore how the global demand reduction affects airlines differently, and provide an analysis of different scenarios if its stays low and does not come back to its pre-crisis level. Using traffic data from the Official Aviation Guide (OAG) and simple assumptions about customer's airline choice strategies, we find that the local effective demand can be much lower than the average one, especially for companies that are not monopolistic and share their segments with larger companies. Even if the average demand comes back to $60\%$ of the total capacity, we find that between $46\%$ and $59\%$ of the companies could experience a reduction of more than $50\%$ of their traffic, depending on the type of competitive advantage that drives customer's airline choice. These results highlight how the complex competitive structure of the WAN weakens its robustness when facing such a large crisis.


docid: psblyhfk

title: ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of thyroid nodules and cancer

text: Most patients with thyroid nodules and thyroid cancer (TC) referred for diagnostic work-up and treatment are not considered at higher risk of infection from SARS-CoV-2 compared to the general population. On the other hand, healthcare resources should be spared to the maximum extent possible during a pandemic. Indeed, while thyroid nodules are very common, only a small percentage are cancerous and, in turn, most thyroid cancers are indolent in nature. Accordingly, diagnostic work-up of thyroid nodules, thyroid surgery for either benign or malignant thyroid nodules and radioiodine treatment for differentiated thyroid cancers may be safely postponed during SARS-CoV-2 pandemic. Appropriate patient counselling, however, is mandatory and red flags should be carefully identified prompting immediate evaluation and treatment as appropriate. For these selected cases diagnostic work-up (e.g. ultrasound, scintigraphy, fine-needle aspiration), surgery and radioiodine therapy may proceed despite the threat of SARS-CoV-2 infection and COVID-19, after an individual risk-benefit analysis.


Commentary: A review of long-term corneal preservation techniques: Relevance and renewed interests in the COVID-19 era


title: Automatic Detection of COVID-19 Cases on X-ray images Using Convolutional Neural Networks

text: In recent months the world has been surprised by the rapid advance of COVID-19. In order to face this disease and minimize its socio-economic impacts, in addition to surveillance and treatment, diagnosis is a crucial procedure. However, the realization of this is hampered by the delay and the limited access to laboratory tests, demanding new strategies to carry out case triage. In this scenario, deep learning models are being proposed as a possible option to assist the diagnostic process based on chest X-ray and computed tomography images. Therefore, this research aims to automate the process of detecting COVID-19 cases from chest images, using convolutional neural networks (CNN) through deep learning techniques. The results can contribute to expand access to other forms of detection of COVID-19 and to speed up the process of identifying this disease. All databases used, the codes built, and the results obtained from the models' training are available for open access. This action facilitates the involvement of other researchers in enhancing these models since this can contribute to the improvement of results and, consequently, the progress in confronting COVID-19.


title: Clinical impact of pre-admission antithrombotic therapy in hospitalized patients with COVID-19: A multicenter observational study

text: Little is still known about the clinical features associated with the occurrence of acute respiratory distress syndrome (ARDS) in hospitalized patients with Coronavirus disease 2019 (COVID-19). The aim of the present study was to describe the prevalence of pre-admission antithrombotic therapies in patients with COVID-19 and to investigate the potential association between antithrombotic therapy and ARDS, as disease clinical presentation, or in-hospital mortality. We enrolled 192 consecutive patients with laboratory-confirmed COVID-19 admitted to emergency department of five Italian hospitals. The study population was divided in two groups according to the evidence of ARDS at chest computed tomography at admission. Propensity score weighting adjusted regression analysis was performed to assess the risk ARDS at admission, and death during hospitalization, in patients treated or not with antiplatelet and anticoagulant agents. ARDS was reported in 73 cases (38 %), who showed more likely hypertension compared to those without ARDS (57.8 % vs 49.6 %; P = 0.005). Thirty-five patients (18.5 %) died during the hospitalization. Not survived COVID-19 patients showed a statistically significant increased age (77 ± 8.31 vs 65.57 ± 8.31; P = 0.001), hypertension (77.1 % vs 53.5 %; P = 0.018) and coronary artery disease prevalence (28.6 % vs 10.2 %; P = 0.009). Both unadjusted and adjusted regression analyses showed no difference in the risk of ARDS at admission, or death during hospitalization, between patients treated or not with antiplatelets or anticoagulants. Pre-admission antithrombotic therapy, both antiplatelet and anticoagulant, does not seem to show a protective effect in severe forms of COVID-19 with ARDS at presentation and rapidly evolving toward death.


Closed Total Laryngectomy During The Covid-19 Pandemic Disease


Coronavirus disease 2019 (COVID-19) pandemic: International variation of personal protective equipment (PPE) and infection prevention and control (IPC) guidelines


COVID-19 and elderly: beyond the respiratory drama


title: Pediatric COVID-19-associated rhabdomyolysis: a case report

text: COVID-19 is the illness caused by infection with the novel coronavirus SARS-CoV-2. Although myalgia is common in adults, it has not been noted as a common symptom in children. There have been a few reported cases of COVID-19-associated rhabdomyolysis in adults. This case report describes a 16-year-old boy who presented with fever, myalgias, mild shortness of breath with exertion, and dark-colored urine. COVID-19 PCR was positive. His initial creatinine kinase (CK) level was 427,656 U/L. Serum creatinine was normal for age. He was treated with isotonic intravenous fluids containing sodium bicarbonate to maintain urine output of 100-200 mL/h and urine pH > 7.0. His serum creatinine remained normal throughout the hospital stay and he was discharged on hospital day 12 with a CK of 6526 U/L. To our knowledge, no pediatric cases of COVID-19-associated rhabdomyolysis have been previously reported. Adult cases of rhabdomyolysis have been reported and a few reports have noted patients with elevated CK levels without rhabdomyolysis. Given this pediatric case of COVID-19-associated rhabdomyolysis, pediatric clinicians should be aware of this complication and manage fluids appropriately in order to prevent acute kidney injury.


Resuscitating Children with COVID-19: What the Pediatric Anesthesiologist Needs to Know


title: [Effect of convalescent plasma and immunoglobulin on patients with severe acute respiratory syndrome: a systematic review]

text: OBJECTIVE: To systematically review evidence for the effect of convalescent plasma and immunoglobulin on treatment of severe acute respiratory syndrome (SARS), and further provide advice on the treatment of coronavirus disease 2019 (COVID-19). METHODS: Clinical studies of convalescent plasma and immunoglobulin in the treatment of SARS were collected from a variety of databases such as PubMed, Cochrane Library, Web of Science, Embase, CNKI, VIP, Wanfang, and CBM from November 2002 to March 2020. Two researchers independently screened the literature, extracted the data, and assessed the risk of bias based on the national institute for health and clinical excellence case series quality scale, and systematically evaluated the results. RESULTS: A total of 10 clinical studies, including 212 patients, were eventually included. There were 4 case series studies, 5 case reports and 1 case-control study. Most studies were with low or very low quality. The systematic analysis showed that 107 patients administered convalescent plasma and 16 patients used immunoglobulin during the treatment of SARS. Forty-nine patients were definitely not treated with the above two methods, and the remaining 40 patients were not reported clearly. The treatment of convalescent plasma and immunoglobulin could both improve the symptoms and reduce the mortality (12 died), and most SARS patients got better, while 11 SARS patients who did not receive the above therapies died. CONCLUSIONS: Convalescent plasma and immunoglobulin were effective on relieving symptoms of SARS patients. However, due to low quality and lacking of control group, convalescent plasma and immunoglobulin should be used with caution to treat COVID-19 patients.


title: Guidelines: Anaesthesia in the context of COVID-19 pandemic

text: OBJECTIVES: The world is currently facing an unprecedented healthcare crisis caused by the COVID-19 pandemic. The objective of these guidelines is to produce a framework to facilitate the partial and gradual resumption of intervention activity in the context of the COVID-19 pandemic. METHODS: The group has endeavoured to produce a minimum number of recommendations to highlight the strengths to be retained in the 7 predefined areas: (1) protection of staff and patients; (2) benefit/risk and patient information; (3) preoperative assessment and decision on intervention; (4) modalities of the preanaesthesia consultation; (5) specificity of anaesthesia and analgesia; (6) dedicated circuits and (7) containment exit type of interventions. RESULTS: The SFAR Guideline panel provides 51 statements on anaesthesia management in the context of COVID-19 pandemic. After one round of discussion and various amendments, a strong agreement was reached for 100% of the recommendations and algorithms. CONCLUSION: We present suggestions for how the risk of transmission by and to anaesthetists can be minimised and how personal protective equipment policies relate to COVID-19 pandemic context.


Coronavirus diaries: to be a scientist


SARS-CoV-2 as a trigger of neurodegeneration: thinking ahead


Practical Techniques to Adapt Surgical Resident Education to the COVID-19 Era


An Italian programme for COVID-19 infection in multiple sclerosis


title: COVID-19, Australia: Epidemiology Report 4 (Reporting week ending 19:00 AEDT 22 February 2020)

text: This is the fourth epidemiological report for coronavirus disease 2019 (COVID-19), reported in Australia as at 19:00 Australian Eastern Daylight Time [AEDT] 22 February 2020. It includes data on COVID-19 cases diagnosed in Australia, the international situation and a review of current evidence.


title: Current situation of COVID-19 in northern Cyprus

text: Background: The public health burden of the novel coronavirus disease 2019 (COVID-19) is expected to increase and urgent strict measures by decision-makers is critical for the containment of the novel coronavirus (SARS-CoV-2) outbreak worldwide. Aims: This study aimed to give a real-time analysis of COVID-19 presence in northern Cyprus. Methods: All official SARS-CoV-2 positive cases were tracked and reported in terms of the origin, nationality, and transmission routes. Preventive measures taken after the first reported case were analyzed for their effectiveness as control strategies. Results: The index case of SARS-CoV-2 in northern Cyprus was identified as a female German tourist. First local case had travel history from the United Kingdom after which local transmission occurred. Rapid and strict containment measures have currently delayed a peak in observed cases. Conclusions: Rapid implementation of social-distancing measures, good hygiene measures and travel/gathering bans in northern Cyprus has been effective in controlling the outbreak.


docid: xxihlncq

title: Cross-lingual Transfer Learning for COVID-19 Outbreak Alignment

text: The spread of COVID-19 has become a significant and troubling aspect of society in 2020. With millions of cases reported across countries, new outbreaks have occurred and followed patterns of previously affected areas. Many disease detection models do not incorporate the wealth of social media data that can be utilized for modeling and predicting its spread. In this case, it is useful to ask, can we utilize this knowledge in one country to model the outbreak in another? To answer this, we propose the task of cross-lingual transfer learning for epidemiological alignment. Utilizing both macro and micro text features, we train on Italy's early COVID-19 outbreak through Twitter and transfer to several other countries. Our experiments show strong results with up to 0.85 Spearman correlation in cross-country predictions.


title: Learning as We Go: An Examination of the Statistical Accuracy of COVID19 Daily Death Count Predictions

text: This paper provides a formal evaluation of the predictive performance of a model (and its various updates) developed by the Institute for Health Metrics and Evaluation (IHME) for predicting daily deaths attributed to COVID19 for each state in the United States. The IHME models have received extensive attention in social and mass media, and have influenced policy makers at the highest levels of the United States government. For effective policy making the accurate assessment of uncertainty, as well as accurate point predictions, are necessary because the risks inherent in a decision must be taken into account, especially in the present setting of a novel disease affecting millions of lives. To assess the accuracy of the IHME models, we examine both forecast accuracy as well as the predictive performance of the 95% prediction intervals provided by the IHME models. We find that the initial IHME model underestimates the uncertainty surrounding the number of daily deaths substantially. Specifically, the true number of next day deaths fell outside the IHME prediction intervals as much as 70% of the time, in comparison to the expected value of 5%. In addition, we note that the performance of the initial model does not improve with shorter forecast horizons. Regarding the updated models, our analyses indicate that the later models do not show any improvement in the accuracy of the point estimate predictions. In fact, there is some evidence that this accuracy has actually decreased over the initial models. Moreover, when considering the updated models, while we observe a larger percentage of states having actual values lying inside the 95% prediction intervals (PI), our analysis suggests that this observation may be attributed to the widening of the PIs. The width of these intervals calls into question the usefulness of the predictions to drive policy making and resource allocation.


docid: adqahvol

title: Insomnia during COVID-19 pandemic and lockdown: Prevalence, severity, and associated risk factors in French population

text: In response to Voitsidis et al. (2020) published in Psychiatry Research addressing the paucity of research on insomnia during a pandemic, we obtained data from an online cross-sectional survey by documenting the prevalence of clinical insomnia and its contributing factors in a French general public sample. Participants (N = 556) completed the Insomnia Severity Index, UCLA Loneliness scale, and provided information on sociodemographics, antecedents of mental and physical health conditions, and COVID-19-related stressful life events. In our sample, 19.1% met the diagnostic criteria of clinical insomnia, which was twice lower than that reported in the study by Voitsidis et al., but close to those found among Chinese and Italian populations. We confirmed COVID-19-related worries and loneliness to be the major contributing factors to clinical insomnia, in addition to education status, being infected by the virus and pre-existing mental health illness. These findings underscore that sleep-related problems should be an important component of mental health interventions during pandemics.


docid: gzwqrgku

title: Robust predictive model for Carriers, Infections and Recoveries (CIR): first update for CoVid-19 in Spain

text: This article reports a first update on the assesment of the model previously presented in arXiv:2003.13890v1. New available data have been used to feed the model and the comparison with real data still shows good agreement. The main novelty of the model is that it keeps track of the date of infection of a single individual and uses stochastic distributions to aggregate individuals who share the same date of infection. In addition, it uses two types of infections, mild and serious, with a different recovery time. These features are implemented in a set of differential equations which determine the number of Carriers, Infections, Recoveries, Hospitalized and Deaths.


"Abandoned" Nursing Homes Continue to Face Critical Supply and Staff Shortages as COVID-19 Toll Has Mounted


title: Clinical characteristics of IgG4-RD patients infected with COVID-19 in Hubei, China

text: OBJECTIVE: IgG4-related disease (IgG4-RD) is an immune-mediated multi-organ, chronic and progressive disease. Therefore, we conducted a study to investigate the susceptibility of COVID-19 in IgG4-RD patients in Hubei province, and to characterize the clinical manifestation of COVID-19 in IgG4-RD patients. METHODS: A follow-up system that includes over 200 IgG4-RD patients across the country during the past ten years. A total of ninety-one patients with IgG4-RD who live in Hubei, China were identified and responded to our survey. Medical history, clinical symptoms, laboratory tests, CT imaging, and treatment were obtained through a standardized data collection form, and then independently reviewed by two investigators. RESULTS: 2 of 91 cases were infected with COVID-19. Both of them were classified as moderate type. The symptoms such as fever and cough and radiologic features were similar to other COVID-19 patients. Neither of them episode recurrent of IgG4-RD nor progressed to severe or critical condition of COVID-19 under the condition of continuous oral low-dose of glucocorticoids. Besides, patient 2 took a long time for SARS-CoV-2 nucleic acid to turn negative. CONCLUSION: IgG4-RD patients may belongs to the susceptible population of COVID-19 infection, and thus need more careful personal protection. Early identification and properly treatment are very important to prevent IgG4-RD patients with COVID-19 from progression to severe condition.


The Emerging Pandemic of Coronavirus and the Urgent Need for Public Health Leadership


title: BETS: The dangers of selection bias in early analyses of the coronavirus disease (COVID-19) pandemic

text: The coronavirus disease 2019 (COVID-19) has quickly grown from a regional outbreak in Wuhan, China to a global pandemic. Early estimates of the epidemic growth and incubation period of COVID-19 may have been biased due to sample selection. Using detailed case reports from 14 locations in and outside mainland China, we obtained 378 Wuhan-exported cases who left Wuhan before an abrupt travel quarantine. We developed a generative model we call BETS for four key epidemiological events---Beginning of exposure, End of exposure, time of Transmission, and time of Symptom onset (BETS)---and derived explicit formulas to correct for the sample selection. We gave a detailed illustration of why some early and highly influential analyses of the COVID-19 pandemic were severely biased. All our analyses, regardless of which subsample and model were being used, point to an epidemic doubling time of 2 to 2.5 days during the early outbreak in Wuhan. A Bayesian nonparametric analysis further suggests that about 5% of the symptomatic cases may not develop symptoms within 14 days of infection and that men may be much more likely than women to develop symptoms within 2 days of infection.


Covid-19: Clinicians must be able to access all test results, pathologists say


title: Knowledge, perceptions and preventive practices towards COVID-19 early in the outbreak among Jimma university medical center visitors, Southwest Ethiopia

text: BACKGROUND: Novel-coronavirus disease-2019 (COVID-19) is currently a pandemic and public health emergency of international concern, as avowed by the World Health Organization (WHO). Ethiopia has become one of the affected countries as of March 15, 2020. OBJECTIVE: This study aimed to assess the knowledge, perceptions, and practices among the Jimma University medical center (JUMC) visitors in Jimma town. METHODS: A cross-sectional study was conducted on 247 sampled visitors, from 20-24 March 2020. Consecutive sampling was used to recruit the participants. The study tools were adapted from WHO resources. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0. Descriptive statistics were used to describe the status of knowledge, perception, and practices. Logistic regression was executed to assess the predictors of dominant preventive practices. RESULTS: Of the 247 respondents, 205 (83.0%) knew the main clinical symptoms of COVID-19. 72.0% knew that older people who have chronic illnesses are at high risk of developing a severe form of COVID-19. About 95.1% knew that the COVID-19 virus spreads via respiratory droplets of infected people, while 77 (31.2%) of the respondents knew about the possibility of asymptomatic transmission. Only 15 (6.1%) knew that children and young adults had to involve preventive measures. Overall, 41.3% of the visitors had high knowledge. The majority, 170(68.8%), felt self-efficacious to controlling COVID-19. 207(83.3%) believed that COVID-19 is a stigmatized disease. Frequent hand washing (77.3%) and avoidance of shaking hands (53.8%) were the dominant practices. Knowledge status and self-efficacy (positively), older age, and unemployment (negatively) predicted hand washing and avoidance of handshaking. CONCLUSIONS: The status of knowledge and desirable practices were not sufficient enough to combat this rapidly spreading virus. COVID-19 risk communication and public education efforts should focus on building an appropriate level of knowledge while enhancing the adoption of recommended self-care practices with special emphasis on high-risk audience segments.


title: Expert Recommendations for Prevention, Treatment and Care of Oral Ulcers and Other Mucosal Diseases during the Coronavirus Outbreak

text: In December 2019, some new and unexplained cases of pneumonia were found in Wuhan, Hubei province, China, and were later named as coronavirus disease 2019 by the World Health Organisation. The number of cases increased rapidly, and the virus spread continuously. Tens of thousands of medical staff throughout the country have since rushed to Wuhan to provide intensive medical treatment. Due to high levels of stress and work intensity, insufficient sleep and a lack of access to water after entering the isolation ward, staff may suffer from oral mucosal ulcers and other oral mucosal diseases. Police officers, community workers, family members in quarantine and even patients with mild coronavirus 2019, as well as those who have previously had oral mucosal disease, have also reported experiencing discomfort as a result of stress-induced oral mucosal disorders, such as recurrent aphthous ulcers, chronic cheilitis and oral lichen planus. This article will offer some suggestions for the prevention, treatment and care of the above-mentioned oral mucosal diseases during the fight against coronavirus 2019, focusing on measures to deal with the oral mucosal damage caused in response to stress.


SARS-CoV-2 RT-PCR: at least 2 viral targets are needed


Evidencia viva como respuesta a las controversias en el uso de antimaláricos en COVID-19./ [Living evidence in response to controversies about the use of antimalarials in COVID-19]


title: Should patients with obesity be more afraid of COVID-19?

text: COVID-19 crisis has lasted since the late 2019 to the present day. The severity of the disease is positively correlated with several factors, such as age and coexisting diseases. Furthermore, obesity is increasingly considered as a yet another risk factor, particularly, because it has been observed that people suffering from excessive body weight may experience a more severe course of COVID-19 infection. On the basis of current research, in our nonsystematic review, we have investigated the extent to which obesity can affect the SARS-CoV-2 course and identify the potential mechanisms of the disease. We have also described the role of proper nutrition, physical activity and other aspects relevant to the management of obesity.


title: Medication management and adherence during the COVID-19 pandemic: Perspectives and experiences from low-and middle-income countries

text: The current coronavirus disease 2019 (COVID-19) pandemic is placing a huge strain on health systems worldwide. Suggested solutions like social distancing and lockdowns in some areas to help contain the spread of the virus may affect special patient populations like those with chronic illnesses who are unable to access healthcare facilities for their routine care and medicines management. Retail pharmacy outlets are the likely facilities for easy access by these patients. The contribution of community pharmacists in these facilities to manage chronic conditions and promote medication adherence during this COVID-19 pandemic will be essential in easing the burden on already strained health systems. This paper highlights the pharmaceutical care practices of community pharmacists for patients with chronic diseases during this pandemic. This would provide support for the call by the WHO to maintain essential services during the pandemic, in order to prevent non-COVID disease burden on healthcare systems particularly in low-and middle-income countries.


title: Clinical characteristics and outcomes of COVID-19 patients with gastrointestinal symptoms admitted to Jianghan Fangcang Shelter Hospital in Wuhan, China

text: OBJECTIVE: Coronavirus disease 2019 (COVID-19) is a health emergency worldwide, and gastrointestinal (GI) symptoms are increasingly reported in COVID-19 patients. However, sample size was small and the incidence of GI symptoms in patients was variable across studies, and the correlation between these symptoms and clinical outcomes remains incompletely understood. The objective of this study is to compare clinical characteristics and outcomes between patients with and without GI symptoms admitted to Jianghan Fangcang Shelter Hospital in Wuhan. METHODS: All patients admitted to Jianghan Fangcang Shelter Hospital were evaluated. Data on epidemiological and clinical characteristics, laboratory findings, treatment procedures, and clinical outcomes were retrieved from electronic medical records. RESULTS: This retrospective study recruited 1320 COVID-19 patients admitted to hospital from February 5, 2020, to March 9, 2020. On the basis of the presence of GI symptoms, the sample was divided into a GI group (n=192) and a non-GI group (n=1128). The most common GI symptoms were diarrhea (8.1%), anorexia (4.7%), and nausea and vomiting (4.3%). The risk of clinical deterioration was significantly higher in the GI group than in the non-GI group (15.6% vs. 10.1%, p=0.032). GI symptoms (p=0.045), male gender (p<0.001), and increased C-reactive protein (p=0.008) were independent risk factors for clinical worsening. CONCLUSION: The risk of clinical deterioration was significantly higher in the GI group. Furthermore, potential risk factors for developing GI symptoms, male gender, and increased C-reactive protein can help clinicians predict clinical outcomes in COVID-19 patients. This article is protected by copyright. All rights reserved.


title: Publisher Correction: A human monoclonal antibody blocking SARS-CoV-2 infection

text: An amendment to this paper has been published and can be accessed via a link at the top of the paper.


COVID-19 and Underinvestment in the Health of the US Population


Concerns regarding self-treatment of burns during COVID-19 lockdown


Vitamin D and Coronavirus


COVID-19 spotlights medical diagnostics


title: Three unsuspected CT diagnoses of COVID-19

text: PURPOSE: Coronavirus disease 2019 (COVID-19) is caused by a novel strain of coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has quickly spread around the globe. Health care facilities in the USA currently do not have an adequate supply of COVID-19 tests to meet the growing demand. Imaging findings for COVID-19 are non-specific but include pulmonary parenchymal ground-glass opacities in a predominantly basal and peripheral distribution. METHODS: Three patients were imaged for non-respiratory-related symptoms with a portion of the lungs in the imaged field. RESULTS: Each patient had suspicious imaging findings for COVID-19, prompting the interpreting radiologist to suggest testing for COVID-19. All 3 patients turned out to be infected with COVID-19, and one patient is the first reported case of the coincident presentation of COVID-19 and an intraparenchymal hemorrhage. CONCLUSION: Using imaging characteristics of COVID-19 on abdominal or neck CT when a portion of the lungs is included, patients not initially suspected of COVID-19 infection can be quarantined earlier to limit exposure to others.


title: Cytokine Storm Drugs Move from CAR T to COVID-19

text: Early reports suggest that tocilizumab, an IL6 receptor-blocking antibody used to manage toxicities associated with chimeric antigen receptor T-cell therapy, may help control cytokine storms in people infected with COVID-19. Preliminary data from randomized trials are less clear-cut.


Current data on the cardiovascular effects of COVID-19


Challenges for NHS hospitals during covid-19 epidemic


Implication of SARS-CoV-2 evolution in the sensitivity of RT-qPCR diagnostic assays


title: Committee Recommendations for Resuming Cardiac Surgery Activity in the SARS-CoV-2 Era: Guidance from an International Cardiac Surgery Consortium

text: Recommendations for the safe and optimized resumption of cardiac surgery care, research and education during the SARS-CoV-2 era were developed by a cardiovascular research consortium, based in 19 countries and representing a wide spectrum of experience with COVID-19. This guidance document provides a framework for restarting cardiac surgery in the outpatient and inpatient settings, in accordance with the current understanding of SARS-CoV-2, the risks posed by interrupted cardiovascular care, and the available recommendations from major societies.


title: Adapting to a global pandemic through live virtual delivery of a cancer collaborative trial group conference: The TROG 2020 experience

text: INTRODUCTION: The global COVID-19 pandemic forced the cancellation of the TROG 2020 face to face Annual Scientific Meeting (ASM). It was instead delivered as a live virtual meeting with 6 days of planning. Here, we report the participants' experience of this live virtual meeting. METHOD: Participants were invited to complete custom-developed, pre- and post-meeting surveys to assess their expectations of and satisfaction with the live virtual format. Speakers and moderators were also invited to complete a custom-developed satisfaction survey. The working parties of TROG (head/neck/skin, genitourinary, breast and lung) were also sampled. RESULTS: In total, 188/273 (69%) registered participants logged in to the live virtual meeting. The online engagement for each of the oral sessions ranged from 53 to 66%. There were 102 and 57 responders to the online pre- and post-meeting surveys, respectively. The majority of pre-meeting responders indicated a significant level of employer support to attend the virtual meeting. Post-meeting satisfaction exceeded pre-meeting expectations ('very much' and 'quite a bit'; 86% vs. 54%; P < 0.0001). The majority indicated they would be 'quite a bit' or 'very much' interested in future live virtual meetings. CONCLUSION: The TROG 2020 ASM was conducted as a live virtual meeting. Participant satisfaction and future interest in a live virtual meeting was high, indicating this is a viable platform for other CCTG's faced with the decision to deliver virtual content at times of global public health threats.


title: Dispersion of a New Coronavirus Sars-cov-2 by Airlines in 2020: Temporal Estimates of the Outbreak in Mexico

text: Background: On January 23, 2020, China imposed a quarantine on the city of Wuhan to contain the SARS-CoV-2 outbreak. Regardless of this measure, the new infection has spread to several countries around the world. Objective: We developed a method to study the dissemination of this infection by airline routes and provide estimations of the time of arrival of the outbreak to different cities. Methods: Using the Kermack and McKendrick model complemented with diffusion on a graph composed of nodes and edges, we made an analysis of COVID-19 dispersion to other cities by air travel. Results: The estimation was accurate in that it was possible to predict in the middle of February 2020 the arrival of the first outbreak in Mexico, which eventually occurred between March 20 and 30. This estimation was robust with respect to small changes in epidemiological parameters at the other nodes. Conclusions: The estimation of the time of arrival of the outbreak from its epicenter, allows for a time period to implement and strengthen preventive measures aimed at the general population as well as to strengthen hospital infrastructure and training of human resources. In the present study, this estimation was accurate, as observed from the real data of the beginning of the outbreak in Mexico City up to April 6, 2020.


title: Ramipril in High Risk Patients with COVID-19

text: BACKGROUND: The coronavirus disease 2019 (COVID-19) is caused by SARS-CoV2 that interfaces with the renin-angiotensin-aldosterone system (RAAS) through angiotensin-converting enzyme 2 (ACE-2). This interaction has been proposed as a potential risk factor in patients treated with RAAS-inhibitors. OBJECTIVES: To analyze if RAAS-inhibitors modify the risk for COVID-19. METHODS: RASTAVI (NCT03201185) is an ongoing randomized clinical trial randomly allocating Ramipril or control after successful transcatheter aortic valve replacement at 14 centers is Spain. We performed a non-pre-specified interim analysis to evaluate its impact on COVID-19 risk in this vulnerable population. RESULTS: As in April 1st 2020, 102 patients (50 Ramipril and 52 controls) were included in the trial. Mean age was 82.3±6.1 years, 56.9% males. Median time of Ramipril treatment was 6 months [IQR:2.9-11.4]. Eleven patients (10.8%) have been diagnosed with COVID-19 (6 in control group and 5 receiving Ramipril, HR=1.150 [95%CI: 0.351-3.768]). The risk of COVID-19 was increased in older patients (p=0.019), those with atrial fibrillation (p=0.066), lower hematocrit (p=0.084), and more comorbidities according to Society of thoracic surgeons score (p=0.065). Admission and oxygen supply was required in 4.9% (2 patients in the Ramipril and 3 in control), and 4 of them died (two in each randomized group). A higher body mass index was the only factor increasing the mortality rate (p=0.039). CONCLUSIONS: In a high risk population of old patients with cardiovascular disease, randomization to Ramipril had no impact in the incidence or severity of COVID-19. This analysis supports the maintenance of RAAS-inhibitor treatment during COVID-19 crisis.


title: Impact of Comorbidities in Mexican Sars-cov-2-positive Patients: a Retrospective Analysis in a National Cohort

text: Background: The coronavirus disease 2019 outbreak is a significant challenge for health-care systems around the world. Objective: The objective of the study was to assess the impact of comorbidities on the case fatality rate (CFR) and the development of adverse events in patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Mexican population. Materials and methods: We analyzed the data from 13,842 laboratory-confirmed SARS-CoV-2 patients in Mexico between January 1, 2020, and April 25, 2020. We investigated the risk of death and the development of adverse events (hospitalization, pneumonia, orotracheal intubation, and intensive care unit [ICU] admission), comparing the number of comorbidities of each patient. Results: The patient mean age was 46.6 ± 15.6 years, 42.3% (n = 5853) of the cases were women, 38.8% of patients were hospitalized, 4.4% were intubated, 29.6% developed pneumonia, and 4.4% had critical illness. The CFR was 9.4%. The risk of hospitalization (odds ratio [OR] = 3.1, 95% confidence interval [CI]: 2.7-3.7), pneumonia (OR = 3.02, 95% CI: 2.6-3.5), ICU admission (OR = 2, 95% CI: 1.5-2.7), and CFR (hazard ratio = 3.5, 95% CI: 2.9-4.2) was higher in patients with three or more comorbidities than in patients with 1, 2, or with no comorbidities. Conclusions: The number of comorbidities may be a determining factor in the clinical course and its outcomes in SARS-CoV-2-positive patients.


Innovation and Knowledge Sharing Can Transform COVID-19 Infection Prevention Response


title: Educating Surgeons to Educate Patients About the COVID-19 Pandemic

text: The spring of 2020 has been a trying time for the global medical community as it has faced the latest pandemic, COVID-19. This contagious and lethal virus has impacted patients and health care workers alike. Elective surgeries have been suspended, and the very core of our health care system is being strained. The following brief communication reviews pertinent details about the virus, delaying elective surgeries, and what patients can do during this time. The goal is to disseminate factual data that surgeons can then use to educate their patients.


title: Air quality changes during the COVID-19 lockdown over the Yangtze River Delta Region: An insight into the impact of human activity pattern changes on air pollution variation

text: The outbreak of COVID-19 has spreaded rapidly across the world. To control the rapid dispersion of the virus, China has imposed national lockdown policies to practise social distancing. This has led to reduced human activities and hence primary air pollutant emissions, which caused improvement of air quality as a side-product. To investigate the air quality changes during the COVID-19 lockdown over the YRD Region, we apply the WRF-CAMx modelling system together with monitoring data to investigate the impact of human activity pattern changes on air quality. Results show that human activities were lowered significantly during the period: industrial operations, VKT, constructions in operation, etc. were significantly reduced, leading to lowered SO2, NOx, PM2.5 and VOCs emissions by approximately 16-26%, 29-47%, 27-46% and 37-57% during the Level I and Level II response periods respectively. These emission reduction has played a significant role in the improvement of air quality. Concentrations of PM2.5, NO2 and SO2 decreased by 31.8%, 45.1% and 20.4% during the Level I period; and 33.2%, 27.2% and 7.6% during the Level II period compared with 2019. However, ozone did not show any reduction and increased greatly. Our results also show that even during the lockdown, with primary emissions reduction of 15%-61%, the daily average PM2.5 concentrations range between 15 and 79 µg m-3, which shows that background and residual pollutions are still high. Source apportionment results indicate that the residual pollution of PM2.5 comes from industry (32.2-61.1%), mobile (3.9-8.1%), dust (2.6-7.7%), residential sources (2.1-28.5%) in YRD and 14.0-28.6% contribution from long-range transport coming from northern China. This indicates that in spite of the extreme reductions in primary emissions, it cannot fully tackle the current air pollution. Re-organisation of the energy and industrial strategy together with trans-regional joint-control for a full long-term air pollution plan need to be further taken into account.


title: Antihyperglycemic properties of hydroxychloroquine in patients with diabetes: Risks and benefits at the time of COVID-19 pandemic

text: The antimalarial drug hydroxychloroquine (HCQ) has long been used as a disease-modifying antirheumatic drug for the treatment of several inflammatory rheumatic diseases. Over the last three decades, various studies have shown that HCQ also plays a role in the regulation of glucose homeostasis. Although the mechanisms of action underlying the glucose-lowering properties of HCQ are still not entirely clear, evidence suggests that this drug may exert multifaceted effects on glucose regulation, including improvement of insulin sensitivity, increase of insulin secretion, reduction of hepatic insulin clearance, and reduction of systemic inflammation. Preliminary studies have shown the safety and efficacy of HCQ (at a dose ranging from 400 to 600 mg/day) in patients with type 2 diabetes over a short-term period. In 2014, HCQ has been approved in India as an add-on hypoglycemic agent for patients with uncontrolled type 2 diabetes. However, large randomized controlled trials are needed to establish the safety and efficacy profile of HCQ in patients with type 2 diabetes over a long-term period. With regard to the COVID-19 pandemic, several medications (including HCQ) have been used as off-label drugs because of the lack of proven effective therapies. However, emerging evidence shows limited benefit from HCQ use in COVID-19 in general. The aim of this manuscript is to comprehensively summarize the current knowledge on the antihyperglycemic properties of HCQ and to critically evaluate the potential risks and benefits related to HCQ use in patients with diabetes, even in light of the current pandemic scenario.


docid: qsfftenu

title: Management challenges for chronic dysimmune neuropathies during the COVID-19 pandemic

text: Since March 2020, the COVID-19 pandemic has led to the need to re-think the delivery of services to patients with chronic dysimmune neuropathies. Telephone/video consultations have become widespread but have compounded concerns about objective evaluation. Therapeutic decisions need, more than ever before, to be considered in the best interests of both patients, and society, while not denying function-preserving/restoring treatment. Immunoglobulin therapy and plasma exchange, for those treated outside of the home, expose patients to the hazards of hospital or outpatient infusion centers. Steroid therapy initiation and continuation pose increased infectious risk. Immunosuppressant therapy similarly becomes highly problematic, with the risks of treatment continuation enhanced by uncertainties regarding duration of the pandemic. The required processes necessitate considerable time and effort especially as resources and staff are re-deployed to face the pandemic, but are essential for protecting this group of patients and as an integral part of wider public health actions.


Do pregnant women have protective immunity against COVID-19?


title: Preserving Access: A Review of Stroke Thrombectomy during the COVID-19 Pandemic

text: Thrombectomy for large-vessel-occlusion stroke is a highly impactful treatment. The spread of coronavirus 19 (COVID-19) across the United States and the globe impacts access to this crucial intervention through widespread societal and institutional changes. In this document, we review the implications of COVID-19 on the emergency care of large-vessel occlusion stroke, reviewing specific infection-control recommendations, available literature, existing resources, and expert consensus. As a population, patients with large-vessel occlusion stroke face unique challenges during pandemics. These are broad in scope. Responses to these challenges through adaptation of stroke systems of care and with imaging, thrombectomy, and postprocedural care are detailed. Preservation of access to thrombectomy must be prioritized for its public health impact. While the extent of required changes will vary by region, tiered planning for both escalation and de-escalation of measures must be a part of each practice. In addition, preparations described serve as templates in the event of future pandemics.


title: Acute immune thrombocytopaenic purpura in a patient with COVID-19 and decompensated cirrhosis

text: We report on a patient with coronavirus disease 2019 (COVID-19) and decompensated cirrhosis who experienced a favourable outcome of severe immune thrombocytopaenic purpura (ITP) after administration of intravenous immunoglobulin and high-dose dexamethasone. The present case suggests that it is reasonable to evoke ITP in case of profound thrombocytopaenia in a patient with COVID-19.


title: Specific organization for in-hospital belatacept infusion to avoid nosocomial transmission during the SARS-CoV-2 pandemic

text: The first cases of Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) occurred in France in early February and in our region (Southwest France) in early March 2020.


Commentary: Addressing Inequities in the Era of COVID-19: The Pandemic and the Urgent Need for Critical Race Theory


docid: znhexizx

title: Association between obesity and clinical prognosis in patients infected with SARS-CoV-2

text: BACKGROUND: It is well established that obesity is a disease of sustained low-grade inflammation. However, it is currently unknown if obesity plays a role in the clinical manifestations and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients. In this study, we aimed to investigate whether obesity played a role in clinical manifestations and prognosis in patients infected with SARS-CoV-2. METHODS: This is a retrospective multicenter clinical study. A total of 96 patients hospitalized with SARS-CoV-2 infection were enrolled from Dongguan People's Hospital, Nanfang hospital and the First Affiliated Hospital of Xiamen University between 23 January and 14 February 2020. Demographic and clinical data were extracted from medical records. Acute respiratory distress syndrome (ARDS) was defined as oxygenation index (PaO2/FiO2) ≤ 300 mmHg. We grouped patients through the body mass index (BMI). Associations were examined using the t test, χ2 test and multivariate logistic forward regression test. RESULTS: Patients with BMI < 24 were significantly younger (P = 0.025) with lower creatine kinase (P = 0.013), lower diastolic pressure blood (P = 0.035), lower serum creatinine (P = 0.012), lower lactate dehydrogenase (P = 0.001) and higher platelet count (P = 0.002). The BMI level was 20.78 ± 3.15 in patients without pneumonia compared with the patients with pneumonia (23.81 ± 3.49, P = 0.001). For patients without ARDS, an average BMI level of 22.65 ± 3.53 was observed, significantly lower than patients with ARDS (24.57 ± 3.59, P = 0.022). The mean BMI was 22.35 ± 3.56 in patients experienced with relieving the clinical symptoms or stable condition by radiographic tests, lower than patients with disease exacerbation with 24.89 ± 3.17 (P = 0.001). In addition, lymphocyte count (r = - 0.23, P = 0.027) and platelet count (r = - 0.44, P < 0.001) were negatively correlated with BMI. While hemoglobin (r = 0.267, P = 0.008), creatine kinase (r = 0.331, P = 0.001), serum creatinine (r = 0.424, P < 0.001) and lactate dehydrogenase (r = 0.343, P = 0.001) were significantly positive correlated with BMI. Multivariate analysis showed that older age (OR = 1.046, P = 0.009) and BMI ≥ 24 (OR = 1.258, P = 0.005) were independent risk factors associated ICU admission while BMI ≥ 24 (OR = 4.219, P = 0.007) was independent risk factor associated with radiographic disease exacerbation. CONCLUSIONS: Our study found BMI was significantly associated with clinical manifestations and prognosis of patients with SARS-CoV-2 infection. For patients with increased risk, clinicians should intervene promptly to avoid disease progression.


Reply to: "Various forms of skin rash in COVID-19: Petechial rash in a patient with COVID-19 infection"


title: Immune Response, Inflammation, and the Clinical Spectrum of COVID-19

text: The current COVID-19 pandemic began in December 2019 in Wuhan (China) and rapidly extended to become a global sanitary and economic emergency. Its etiological agent is the coronavirus SARS-CoV-2. COVID-19 presents a wide spectrum of clinical manifestations, which ranges from an asymptomatic infection to a severe pneumonia accompanied by multisystemic failure that can lead to a patient's death. The immune response to SARS-CoV-2 is known to involve all the components of the immune system that together appear responsible for viral elimination and recovery from the infection. Nonetheless, such immune responses are implicated in the disease's progression to a more severe and lethal process. This review describes the general aspects of both COVID-19 and its etiological agent SARS-CoV-2, stressing the similarities with other severe coronavirus infections, such as SARS and MERS, but more importantly, pointing toward the evidence supporting the hypothesis that the clinical spectrum of COVID-19 is a consequence of the corresponding variable spectrum of the immune responses to the virus. The critical point where progression of the disease ensues appears to center on loss of the immune regulation between protective and altered responses due to exacerbation of the inflammatory components. Finally, it appears possible to delineate certain major challenges deserving of exhaustive investigation to further understand COVID-19 immunopathogenesis, thus helping to design more effective diagnostic, therapeutic, and prophylactic strategies.


docid: dwxuwebr

title: A Recommender System For Open Educational Videos Based On Skill Requirements

text: In this paper, we suggest a novel method to help learners find relevant open educational videos to master skills demanded on the labour market. We have built a prototype, which 1) applies text classification and text mining methods on job vacancy announcements to match jobs and their required skills; 2) predicts the quality of videos; and 3) creates an open educational video recommender system to suggest personalized learning content to learners. For the first evaluation of this prototype we focused on the area of data science related jobs. Our prototype was evaluated by in-depth, semi-structured interviews. 15 subject matter experts provided feedback to assess how our recommender prototype performs in terms of its objectives, logic, and contribution to learning. More than 250 videos were recommended, and 82.8% of these recommendations were treated as useful by the interviewees. Moreover, interviews revealed that our personalized video recommender system, has the potential to improve the learning experience.


Acute polyradiculoneuritis with locked-in syndrome in a patient with Covid-19


title: Comparative analysis of Coronaviridae nucleocapsid and surface glycoprotein sequences

text: We analyzed the nucleocapsid and surface proteins from several Coronaviridae viruses using an alignment-free computer program. Three isolates of novel, human coronavirus (SARS0CoV-2) (2019) that are responsible for the current pandemic and older SARS strains of human and animal coronaviruses were examined. The nucleocapsid and glycoprotein sequences are identical for the three novel 2019 human isolates and they are closely related to these sequences in six bat and human SARS coronaviruses. This strongly supports the bat origin of the pandemic, novel coronavirus. One surface glycoprotein fragment of 111 amino acids is the largest, conserved, common permutation in the examined bat SARS-like and human SARS viruses, including the Covid-19 virus. BLAST analysis confirmed that this fragment is conserved only in the human and bat SARS strains. This fragment likely is involved in infectivity and is of interest for vaccine development. Surface glycoprotein and nucleocapsid protein sequence homologies of 58.9% and 82.5%, respectively, between the novel SARS0CoV-2 strains and the human SARS (2018) virus suggest that existing anti-SARS vaccines may provide some protection against the novel coronavirus.


Protecting dental manpower from COVID-19 infection


COVID-19 admissions calculators - revisited


Ethical and Legal Challenges During the COVID-19 Pandemic: Are We Thinking About Rural Hospitals?


title: Modelling the downhill of the Sars-Cov-2 in Italy and a universal forecast of the epidemic in the world

text: In a previous article [1] we have described the temporal evolution of the Sars- Cov-2 in Italy in the time window February 24-April 1. As we can see in [1] a generalized logistic equation captures both the peaks of the total infected and the deaths. In this article our goal is to study the missing peak, i.e. the currently infected one (or total currently positive). After the April 7 the large increase in the number of swabs meant that the logistical behavior of the infected curve no longer worked. So we decided to generalize the model, introducing new parameters. Moreover, we adopt a similar approach used in [1] (for the estimation of deaths) in order to evaluate the recoveries. In this way, introducing a simple conservation law, we define a model with 4 populations: total infected, currently positives, recoveries and deaths. Therefore, we propose an alternative method to a classical SIRD model for the evaluation of the Sars-Cov-2 epidemic. However, the method is general and thus applicable to other diseases. Finally we study the behavior of the ratio infected over swabs for Italy, Germany and USA, and we show as studying this parameter we recover the generalized Logistic model used in [1] for these three countries. We think that this trend could be useful for a future epidemic of this coronavirus.


title: Adaptation to SARS-CoV-2 under stress: Role of distorted information

text: BACKGROUND: Since the time of global SARS-CoV-2 spread across the earth in February 2020, most of countries faced the problem of massive stress of their healthcare systems. In many cases, the structural stress was a result of incorrect allocation of medical care resources. In turn, this misallocation resulted from fear and apprehensions that superseded thorough calculations. A key role in exacerbating the healthcare sector overburdening was played by misleading information on the virus and disease caused by it. In the current paper, we study the situation in Russian healthcare system and advance recommendations how to avoid further crises. MATERIALS AND METHODS: (a) Surveying the medical personnel (231 doctors, 317 nurses and 355 ambulance medical workers of lower levels) in five hospitals and six ambulance centres in Moscow. (b) Content analysis of 3164 accounts in Russian segment of social networks (VKontakte, Facebook, Instagram, Twitter, Odnoklassniki); official and unofficial media (TV, informational webpages). RESULTS: We revealed positive-feedback loop that threatened the sustainability of Russian care sector. The main knot was occupied by incorrect/exaggerated media coverage of COVID-19. General public scared by misinformation in media and social networks, started to panic. This negative social background undermined the productivity of a significant part of medical workers who were afraid of COVID-19 patients. CONCLUSIONS: The most serious problems of Russian healthcare sector related to COVID-19 pandemic, were informational problems. The exaggerated information on COVID-19 had big negative influence upon Russian society and healthcare system, despite SARS-CoV-2 relatively low epidemiological hazard.


title: Malnutrition, enamel defects, and early childhood caries in preschool children in a sub-urban Nigeria population

text: OBJECTIVES: The study tried to determine if malnutrition (underweight, stunting, wasting, overweight) and enamel defects (enamel hypoplasia, hypomineralized second molar, amelogenesis imperfecta, fluorosis) were associated with early childhood caries (ECC). The study also examined whether malnutrition was associated with the presence of enamel defects in 0-5-year-old children. METHODS: The study was a secondary analysis of primary data of a cross-sectional study assessing the association between maternal psychosocial health and ECC in sub-urban Nigerian population collected in December 2018 and January 2019. One hundred and fifty nine children were recruited. Exploratory variables were malnutrition and enamel defects. The outcome variables were the prevalence of ECC in 0-2-year-old, 3-5-year-old, and 0-5-year-old children. Multivariable Poisson regression analysis was used to determine the associations, and socioeconomic status, oral hygiene status, and frequency of in-between-meals sugar consumption were adjusted for. The adjusted prevalence ratios, 95% confidence intervals, and p values were calculated. RESULTS: The prevalence of ECC was 2.1% in 0-2-year-old children and 4.9% in 3-5-year-old children. In adjusted models, underweight, stunting, and wasting/overweight were not significant risk indicators for ECC in either age group. 0-2-year-old children who had amelogenesis imperfecta (p<0.001) and fluorosis (p<0.001) were more likely to have ECC than were children who did not have these lesions. 3-5-year-old children who had hypoplasia (p = 0.004), amelogenesis imperfecta (p<0.001) and fluorosis (p<0.001) were more likely to have ECC than were children who did not have these lesions. 0-5-year-old children with hypoplasia (p<0.001) and fluorosis (p<0.001) were more likely to have ECC than were children who did not have these lesions. There were significant associations between various types of malnutrition and various types of enamel defects. CONCLUSION: Although different types of malnutrition were associated with enamel defects, and enamel defects were associated with ECC, malnutrition was not associated with ECC. Further studies are needed to clarify the association between malnutrition and genetically and toxin-induced enamel defects.


title: Coronavirus Disease 2019 in Pregnancy: A Clinical Management Protocol and Considerations for Practice

text: The coronavirus disease 2019 (COVID-19) pandemic has represented a major impact to health systems and societies worldwide. The generation of knowledge about the disease has occurred almost as fast as its global expansion. The mother and fetus do not seem to be at particularly high risk. Nevertheless, obstetrics and maternal-fetal medicine practice have suffered profound changes to adapt to the pandemic. In addition, there are aspects specific to COVID-19 and gestation that should be known by specialists in order to correctly diagnose the disease, classify the severity, distinguish specific signs of COVID-19 from those of obstetric complications, and take the most appropriate management decisions. In this review we present in a highly concise manner an evidence-based protocol for the management of COVID-19 in pregnancy. We briefly contemplate all relevant aspects that we believe a specialist in obstetrics and maternal medicine should know, ranging from basic concepts about the disease and protection measures in the obstetric setting to more specific aspects related to maternal-fetal management and childbirth.


title: Investigação molecular de Ehrlichia canis, Anaplasma platys, Anaplasma phagocytophilum e Rickettsia spp. em felídeos selvagens cativos/ Molecular investigation of Ehrlichia canis, Anaplasma platys, Anaplasma phagocytophilum and Rickettsia spp. in captive wild felids

text: Doenças transmitidas por vetores estão emergindo e reemergindo em todo o mundo, representando um desafio na medicina humana e veterinária. Entre essas doenças estão aquelas causadas pelos agentes da ordem das Rickettsiales, que são bactérias Gram-negativas intracelulares obrigatórias, com capacidade de infectar vários animais e seres humanos. As Rickettsiales das espécies Ehrlichia spp. e Anaplasma spp. são observadas em vacúolos citoplasmáticos de leucócitos e plaquetas. As Rickettsiales da espécie Rickettsia spp. infectam livremente citoplasma ou núcleo de células hospedeiras. O objetivo do presente estudo foi investigar a infecção natural por Ehrlichia canis, Anaplasma platys, Anaplasma phagocytophilum e Rickettsia spp. em felídeos selvagens cativos no Distrito Federal e Goiás, Brasil. Além disso, também objetivou-se relacionar possíveis alterações hematológicas decorrentes da presença desses agentes. Amostras de sangue de 34 animais foram analisadas por meio da PCR para detecção de presença de DNA desses agentes. O DNA de Ehrlichia canis foi detectado em 5,8% (2/34) das amostras, A. platys foi detectado 64,7% (22/34), A. phagocytophilum foi detectado em 5,8% (2/34). O DNA de Rickettsia spp. não foi detectado em nenhuma amostra. Dois felídeos apresentaram coinfecção por E. canis e A. platys e dois apresentaram coinfecção por A. platys e A. phagocytophilum. Não houve diferenças significativas nos dados hematológicos das amostras positivas e negativas. Os dados sugerem que os felídeos selvagens cativos podem servir como potenciais reservatórios para Ehrlichia spp. e Anaplasma spp., a despeito de não ocasionarem alterações hematológicas.(AU)


title: COVID-19 and Other Pandemics: How Might They Be Prevented?

text: Pandemics such as influenza, smallpox, and plague have caused the loss of hundreds of millions of lives and have occurred for many centuries. Fortunately, they have been largely eliminated by the use of vaccinations and drugs. More recently, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and now Coronavirus Disease 2019 (COVID-19) have arisen, and given the current absence of highly effective approved vaccines or drugs, brute-force approaches involving physical barriers are being used to counter virus spread. A major basis for physical protection from respiratory infections is eye, nose, and mouth protection. However, eye protection with goggles is problematic due to "fogging", while nose/mouth protection is complicated by the breathing difficulties associated with non-valved respirators. Here, we give a brief review of the origins and development of face masks and eye protection to counter respiratory infections on the basis of experiments conducted 100 years ago, work that was presaged by the first use of personal protective equipment, "PPE", by the plague doctors of the 17th Century. The results of the review lead to two conclusions: first, that eye protection using filtered eye masks be used to prevent ocular transmission; second, that new, pre-filtered, valved respirators be used to even more effectively block viral transmission.


title: Prolonged fecal shedding of SARS-CoV-2 in pediatric patients. A quantitative evidence synthesis

text: OBJECTIVE: To investigate differences in viral shedding in respiratory and fecal samples from children with COVID-19. METHODS: We searched PubMed, SCOPUS, Embase and Web of Science databases to identify pediatric studies comparing the pattern of fecal and respiratory shedding of SARS-CoV-2 RNA. Summary estimates were calculated using random-effects models. RESULTS: Four studies reporting data from 36 children were included. A higher proportion of children had viral shedding in stools after 14 days of symptoms onset compared to respiratory samples (RR= 3.2, 95%CI 1.2 to 8.9, I2 = 51%). Viral RNA shedding was longer in fecal samples with a mean difference of approximately 9 days (Mean Difference = 8.6, 95%CI 1.7 to 15.4, I2â=â77%) compared with respiratory samples. CONCLUSION: SARS-CoV-2 shedding seems to be present in feces for a longer time than in the respiratory tract of children. Although fecal SARS-CoV-2 presence in feces do not confirm its transmissibility, the high and fast spread of the COVID-19 disease worldwide indicate other transmission routes are also plausible.


title: COVID-19 pneumonia and immune-related pneumonitis: critical issues on differential diagnosis, potential interactions, and management

text: INTRODUCTION: The COVID-19 pandemic occurred amid the cancer immunotherapy revolution. Immune checkpoint inhibitors (ICIs) have become the standard of care for several solid cancers and are associated with peculiar toxicities, including pneumonitis which has similar features to COVID-19 pneumonia. AREAS COVERED: We summarize the main hallmarks of lung injury induced by ICIs and severe acute respiratory syndrome coronavirus 2 and discuss the critical aspects for differential diagnosis and management. Symptoms and radiological findings are often similar; conversely, treatments are quite different. Furthermore, we focus on potential interactions generating hypotheses that need confirmatory studies. EXPERT OPINION: All cancer patients treated with immunotherapy should receive screening for SARS-CoV-2. This would improve the diagnosis and management of pneumonia and guide therapeutic choices. Furthermore, clinicians could estimate the risk/benefit of continuing ICI treatment in COVID-19 positive patients. Temporary withdrawal of the immunotherapy treatment pending resolution of viral infection may be a reasonable option in long-responders patients.


COVID-19 Pneumonia and Immune-Related Pneumonitis: critical issues on differential diagnosis, potential interactions and management


title: Encouragement to submit manuscripts-suggestions from a Japanese Associate Editor of Acta Cirurgica Brasileira

text: Medicine can be broadly divided into two fields: clinical medicine that aims to save existing patients and basic medical research that aims to save the lives of future patients. In terms of disseminating basic medical research, medical journals play a vital role for physicians and scientists, as they enable them to share experiences. The author, who has been serving as an Associate Editor of the Brazilian journal Acta Cirurgica Brasileira over a long period of time, wishes to encourage physicians and researchers to submit their papers to medical journals. As we currently face the difficult battle against COVID-19 pandemic, physicians worldwide must team up and fight the virus for the safety of our future generations.


Response to: RILI model and the Covid-19 pneumonia: The radiation oncologist point of view


Drug Evaluation during the Covid-19 Pandemic


title: [Asymptomatic SARS-CoV-2 infection in children: a clinical analysis of 20 cases]

text: OBJECTIVE: To study the clinical and epidemiological features of children with asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: The clinical data of 20 children who were diagnosed with asymptomatic SARS-CoV-2 infection from January 20 to March 4, 2020 were analyzed. RESULTS: Among the 20 children, there were 7 boys (35%) and 13 girls (65%), aged 8 months to 14 years (mean 8±5 years). All these children had no clinical manifestations and attended the hospital for an epidemiological history of SARS-CoV-2. Nineteen children were shown with family aggregation of SARS-CoV-2 infection. Nasopharyngeal swabs were PCR-positive for SARS-CoV-2 in all 20 children. There were 4 children (20%) of mild type, 16 children (80%) of common type, and no children of severe type or critical type. The mean peripheral blood leukocyte count was (6.8±3.5)×109/L, and 7 children had an abnormal peripheral blood leukocyte count, with an increase in 5 children and a reduction in 2 children. One child had a decreased absolute value of lymphocytes (0.87×109/L), 3 children had an increased erythrocyte sedimentation rate (20-42â mm/h), 7 children had an increased lactate dehydrogenase level (>400â U/L), and 4 children had an increased blood lactate level (>1.6â mmol/L). Chest CT showed single or multiple small nodule shadows, patchy shadows, and ground-glass shadows in the middle or lateral lobe of lungs or under the pleura in 13 children. CONCLUSIONS: Pediatric cases of asymptomatic SARS-CoV-2 infection mostly occur with family aggregation. Most of the children with asymptomatic infection have no obvious abnormalities in blood routine and other laboratory tests. Changes in chest CT scan can be used as an aid for early diagnosis of asymptomatic infection in children.


Clinical characteristics associated with persistent olfactory and taste alterations in COVID-19: A preliminary report on 121 patients


title: What proportion of healthcare worker masks carry virus? A systematic review

text: BACKGROUND: Concerns have been raised by healthcare organisations in New Zealand that routine mask use by healthcare workers (HCW) may increase the risk of transmission of SARS-CoV-2 through increased face touching. Routine mask use by frontline HCW was not recommended when seeing 'low risk' patients. The aim of this review was to determine the carriage of respiratory viruses on facemasks used by HCW. METHODS: A systematic review was conducted with structured searches of medical and allied health databases. Two authors independently screened articles for inclusion, with substantial agreement (k=0.66, 95%CI 0.54 to 0.79). Studies that at least one author recommended for full text review were reviewed in full for inclusion. Two authors independently extracted data from included studies including the setting, method of analysis and results. There was exact agreement on the proportion of virus detected on masks. RESULTS: 1233 titles were retrieved, 47 underwent full text review and five studies reported in four articles were included. The studies were limited by small numbers and failure to test all eligible masks in some studies. The proportion in each study ranged from 0 (95% CI 0-10) to 25% (95%CI 8-54). No study reported clinical respiratory illness as a result of virus on the masks. CONCLUSIONS: Although limited, current evidence suggests that viral carriage on the outer surface of surgical masks worn by HCW treating patients with clinical respiratory illness is low and there was not strong evidence to support the assumption that mask use may increase the risk of viral transmission. This article is protected by copyright. All rights reserved.


title: Diagnostic performance between CT and initial real-time RT-PCR for clinically suspected 2019 coronavirus disease (COVID-19) patients outside Wuhan, China

text: INTRODUCTION: Chest CT is thought to be sensitive but less specific in diagnosing the 2019 coronavirus disease (COVID-19). The diagnostic value of CT is unclear. We aimed to compare the performance of CT and initial RT-PCR for clinically suspected COVID-19 patients outside the epicentre-Wuhan, China. MATERIALS AND METHODS: Patients clinically suspected of COVID-19 infection who underwent initial RT-PCR and chest CT at the same time were retrospectively enrolled. Two radiologists with specific training reviewed the CT images independently and final diagnoses of the presence or absence of COVID-19 was reached by consensus. With serial RT-PCR as reference standard, the performance of initial RT-PCR and chest CT was analysed. A strategy of combining initial RT-PCR and chest CT was analysed to study the additional benefit. RESULTS: 82 patients admitted to hospital between Jan 10, 2020 to Feb 28, 2020 were enrolled. 34 COVID-19 and 48 non-COVID-19 patients were identified by serial RT-PCR. The sensitivity, specificity was 79% (27/34) and 100% (48/48) for initial RT-PCR and 77% (26/34) and 96% (46/48) for chest CT. The image readers had a good interobserver agreement with Cohen's kappa of 0.69. No statistical difference was found in the diagnostic performance between initial RT-PCR and chest CT. The comprehensive strategy had a higher sensitivity of 94% (32/34). CONCLUSIONS: Initial RT-PCR and chest CT had comparable diagnostic performance in identification of suspected COVID-19 patients outside the epidemic center. To compensate potential risk of false-negative PCR, chest CT should be applied for clinically suspected patients with negative initial RT-PCR.